Magnitude Of Disparity Research Articles

Disparities in Premature Deaths Attributable to Fine Particulate Matter (PM2.5) Exposure between Immigrants to and those born in the United States

Background: Immigrants to the United States (US) experience different health risks compared to those born in the US. It is unknown if different levels of environmental exposures such as ambient fine particulate matter (PM2.5) contribute to immigrant health disparities. Methods: We compiled counts of immigrants (i.e., foreign-born) and US-born living in each Census tract in 2000 and 2010 from the Census Bureau. With ground-level ambient PM2.5 exposure surfaces from a validated spatiotemporal model, we then calculated the average annual PM2.5 exposure for the US-born, immigrants, and immigrant subgroups by country of origin. Among these population subgroups, we estimated disparities in PM2.5 exposure and premature deaths attributable to PM2.5 exposure. Results: In 2000, the total number of immigrants living in the US was 30.86 million compared to 248.72 million US-born while in 2010, there were 38.39 million immigrants and 263.55 million US-born. On average, in 2000 immigrants were exposed to PM2.5 levels 1.25 µg/m3 higher than those of the US-born and 0.36 µg/m3 higher PM2.5 in 2010. The disparity of premature deaths attributable to PM2.5 exposure in immigrants compared to the US-born was +7.06 (95% CI: 5.58, 8.56) deaths/100,000 people in 2000 and +1.71 (95% CI: 0.84, 2.58) deaths/100,000 people in 2010. We found heterogeneity spatially and by immigrants’ country of origin, with higher premature deaths attributable to PM2.5 among immigrants from Africa, Asia, and Latin America compared to immigrants from elsewhere. Conclusions: Overall, immigrants were higher-exposed and thus more susceptible to premature mortality attributable to PM2.5 compared to the US-born. This magnitude of the mortality disparity is greater than the number of premature deaths each year from a foodborne illness such as E.coli. Heterogeneity by country of origin suggests that environmental exposures such as PM2.5 may contribute to health disparities among immigrants (i.e. by country of origin).

Lessons from the Losing: Implications of the COVID‐19 Pandemic for Organizational Diversity Scholarship and Practice

Abstract Organizational profitability and survival are often contingent on the ability to respond to crises effectively (Pearson and Clair, 1998) In this essay, I contend that considering the impact of country composition and culture during the COVID-19 pandemic can enhance our comprehension of the role of diversity during duress When crises occur, demographic differences tend to be especially salient, as individuals become more attentive to protecting the perceived interests of the in-group, often at the expense of outgroups (King, Knight and Hebl, 2010;Krosch, Tyler, and Amodio, 2017)

Magnitude and trends in socio-economic and geographic inequality in access to birth by cesarean section in Tanzania: evidence from five rounds of Tanzania demographic and health surveys (1996\u20132015)

BackgroundMajority of maternal deaths are avoidable through quality obstetric care such as Cesarean Section (CS). However, in low-and middle-income countries, many women are still dying due to lack of obstetric services. Tanzania is one of the African countries where maternal mortality is high. However, there is paucity of evidence related to the magnitude and trends of disparities in CS utilization in the country. This study examined both the magnitude and trends in socio-economic and geographic inequalities in access to birth by CS.MethodsData were extracted from the Tanzania Demographic and Health Surveys (TDHSs) (1996–2015) and analyzed using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software. First, access to birth by CS was disaggregated by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference (D), Ratio (R), Slope Index of Inequality (SII) and Relative Index of Inequality (RII). A 95% confidence interval was constructed for point estimates to measure statistical significance.ResultsThe results showed variations in access to birth by CS across socioeconomic, urban-rural and regional subgroups in Tanzania from 1996 to 2015. Among the poorest subgroups, there was a 1.38 percentage points increase in CS coverage between 1996 and 2015 whereas approximately 11 percentage points increase was found among the richest subgroups within same period of time. The coverage of CS increased by nearly 1 percentage point, 3 percentage points and 9 percentage points among non-educated, those who had primary education and secondary or higher education, respectively over the last 19 years. The increase in coverage among rural residents was 2 percentage points and nearly 8 percentage points among urban residents over the last 19 years. Substantial disparity in CS coverage was recorded in all the studied surveys. For instance, in the most recent survey, pro-rich (RII = 15.55, 95% UI; 10.44, 20.66, SII = 15.8, 95% UI; 13.70, 17.91), pro-educated (RII = 13.71, 95% UI; 9.04, 18.38, SII = 16.04, 95% UI; 13.58, 18.49), pro-urban (R = 3.18, 95% UI; 2.36, 3.99), and subnational (D = 16.25, 95% UI; 10.02, 22.48) absolute and relative inequalities were observed.ConclusionThe findings showed that over the last 19 years, women who were uneducated, poorest/poor, living in rural settings and from regions such as Zanzibar South, appeared to utilize CS services less in Tanzania. Therefore, such subpopulations need to be the central focus of policies and programmes implemmentation to improve CS services coverage and enhance equity-based CS services utilization.

Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood.

Sexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985-2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities. Age- and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed meta-analyzed data were used to infer period effects among sexual minorities of all genders. We identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18-20years of age for both genders) and one peak nearing mid-life (30-35years of age for men; 35-40years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity. In the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course.

Explaining Gender Disparity in Risky Sexual Behavior among Undergraduate University Students in Ethiopia

ABSTRACTObjective: The aim of this research is to explain gender disparity in risky sexual behaviors among undergraduate students in Ethiopia.Setting: this study was conducted at Dambi Dollo University undergraduate students in Ethiopia. Participants: From the total of 633 sample size 579 received and returned complete questionnaire from which 330 were males and 279 were females. Simple random sampling method was used to select the participants. Respondents enrolled under other programs than regular program were excluded.Primary outcome: risky sexual behaviour is the primary outcome measured in this study. It is derived from any sexual act that can enhance the transmission of sexually transmitted infections including HIV and unplanned pregnancy. STATA 15 was used for data management and analysis. A multivariate decomposition analysis for non-linear model was used to determine the magnitude and drivers of gender disparity in risky sexual behavior. Latent class analysis was also used to produce latent class in HIV/AIDS related knowledge.Result: There is a 33.2% extra risk in sexual behavior among males with a 95% CI (26.4, 39.9). Of this disparity, 32.6% with 95% CI (6.5 to 15.1), p<0.001, is attributable to differences in characteristics between boys and girls. The remaining 67.4% with a 95% CI (14.1 to 30.6), P<0.001, of the raw difference is, however, explained by the differences in response behavior to changes in characteristics between the sexes. Being Muslim, communication with parents, communication with friends, substance use and knowledge about HIV/AIDS explained the observed male-female gap in risky sexual behavior.Conclusions: Addressing gender inequalities in risky sexual behavior among youth requires gender sensitive policies and strategies. Risk reduction strategies should focus on religions, parents and peers. Policy on substance ban should be in place and effectively administered. Gender sensitive awareness raising and educational programs about substance use and HIV/AIDS should be strengthened.

Oral Health Inequalities among Indigenous and Non-Indigenous Children.

Our ability to address child oral health inequalities would be greatly facilitated by a more nuanced understanding of whether underlying disease experience or treatment opportunities account for a larger share of differences between social groups. This is particularly relevant in the context of population subgroups who are socially marginalized, such as Australia's Indigenous population. The decayed, missing, and filled (dmf) surfaces index is at once a reflection of dental caries experience (d) and its management (m and f). To 1) describe socioeconomic inequalities in dental caries experience and its management among Indigenous and non-Indigenous children and 2) compare these inequalities using absolute and relative measures. Data were from the Australian National Child Oral Health Study 2012-2014. Absolute and relative income inequalities were assessed for overall dmfs and its individual components (ds, ms, fs) using adjusted means and health disparity indices (Slope Index of Inequality [SII] and Relative Index of Inequality [RII]). Mean dmfs among Indigenous children aged 5 to 10 y was 6.4 (95% confidence interval [CI], 5.4-7.4), ranging from 2.3 in the highest to 9.1 in the lowest income group. Mean dmfs among non-Indigenous children was 2.9 (95% CI, 2.8-3.1), ranging from 1.9 in the highest to 4.2 in the lowest income group. Age- and gender-adjusted social gradients for Indigenous children were evident across all dmfs components but were particularly notable for ds (SII = -4.6, RII = -1.7) and fs (SII = -3.2, RII = -1.5). The social gradients for non-Indigenous children were much lower in magnitude: ds (SII = -1.8, RII = -1.6) and fs (SII = -0.7, RII = -0.5). Our findings suggest that socioeconomic disadvantage may translate into both higher disease experience and increased use of dental services for both Indigenous and non-Indigenous groups, with the social gradients being much more amplified among Indigenous children. The findings of this study demonstrate the magnitude of disparities in dental caries among children by population groups in Australia. Our results suggest that the relationship between socioeconomic disadvantage and poor oral health is more deleterious among Indigenous than non-Indigenous children. Tackling upstream determinants of health might not only affect population patterns of health and disease but also mitigate the overwhelming racial inequalities in oral health between Indigenous and non-Indigenous Australians.

Substance Use Disparities at the Intersection of Sexual Identity and Race/Ethnicity: Results from the 2015-2018 National Survey on Drug Use and Health.

Purpose: Lesbian, gay, and bisexual (LGB) racial/ethnic minority individuals experience minority stress due to both their sexual identity and race/ethnicity and may be at elevated substance use risk (relative to heterosexuals) compared with their White LGB peers. We examined differences in the presence and magnitude of substance use disparities among LGB adults across race/ethnicity. Methods: Using data on 168,560 adults (including 11,389 LGB adults) from the 2015-2018 National Survey on Drug Use and Health, we examined disparities in cigarette smoking, heavy episodic drinking (HED), and marijuana use by race/ethnicity (White, Black, Hispanic, and other race/multiracial). Analyses compared lesbian/gay and bisexual adults, respectively, with heterosexual adults of the same gender and race/ethnicity. We also tested the magnitude of racial/ethnic minority disparities relative to the corresponding White disparity. Results: Significant disparities in smoking, HED, and marijuana use were observed for lesbian/gay and bisexual women across nearly all racial/ethnic groups. Disparities were consistently greater in magnitude for Black and Hispanic LGB women compared with White LGB women. Few disparities were observed among men; the magnitude of observed disparities did not differ by race/ethnicity. Conclusion: Disparities were most pronounced among racial/ethnic minority LGB women, which may reflect their unique experiences of discrimination at the intersection of multiple minority idenities. However, racial/ethnic minority gay and bisexual men were not at elevated risk relative to their White counterparts. Future research on substance use disparities among LGB individuals using an intersectional framework is warranted to elucidate differential minority stress processes that contribute to the observed heterogeneity across race/ethnicity, sexual identity, and gender.

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.

Salary Disparities in Academic Urogynecology: Despite Increased Transparency, Men Still Earn More Than Women.

To understand the compensation differences between male and female academic urogynecologists at public institutions. Urogynecologists at public universities with publicly available salary data as of June 2019 were eligible for the study. We collected characteristics, including sex, additional advanced degrees, years of training, board certification, leadership roles, number of authored scientific publications, and total National Institutes of Health funding projects and number of registered clinical trials for which the physician was a principal or co-investigator. We also collected total number of Medicare beneficiaries treated and total Medicare reimbursement as reported by the Centers for Medicare & Medicaid Services. We used linear regression to adjust for potential confounders. We identified 85 academic urogynecologists at 29 public state academic institutions with available salary data eligible for inclusion in the study. Males were more likely to be an associate or a full professor (81%) compared with females (55%) and were more likely to serve as department chair, vice chair, or division director (59%) compared with females (30%). The mean annual salary was significantly higher among males ($323,227 ± $97,338) than females ($268,990 ± $72,311, P = 0.004). After adjusting for academic rank and leadership roles and years since residency, the discrepancy persisted, with females compensated on average $37,955 less annually. Salaries are higher for male urogynecologists than female urogynecologists, even when accounting for variables such as academic rank and leadership roles. Physician compensation is complex; the differences observed may be due to variables that are not captured in this study. Nevertheless, the magnitude of disparity found in our study warrants further critical assessment of potential biases within the field.

Multivariate Analysis of Black Race and Environmental Temperature on COVID-19 in the US

BackgroundThere has been much interest in environmental temperature and race as modulators of Coronavirus disease-19 (COVID-19) infection and mortality. However, in the United States race and temperature correlate with various other social determinants of health, comorbidities, and environmental influences that could be responsible for noted effects. This study investigates the independent effects of race and environmental temperature on COVID-19 incidence and mortality in United States counties. MethodsData on COVID-19 and risk factors in all United States counties was collected. 661 counties with at least 50 COVID-19 cases and 217 with at least 10 deaths were included in analyses. Upper and lower quartiles for cases/100,000 people and halves for deaths/100,000 people were compared with t-tests. Adjusted linear and logistic regression analyses were performed to evaluate the independent effects of race and environmental temperature. ResultsMultivariate regression analyses demonstrated Black race is a risk factor for increased COVID-19 cases (OR=1.22, 95% CI: 1.09–1.40, P=0.001) and deaths independent of comorbidities, poverty, access to health care, and other risk factors. Higher environmental temperature independently reduced caseload (OR=0.81, 95% CI: 0.71–0.91, P=0.0009), but not deaths. ConclusionsHigher environmental temperatures correlated with reduced COVID-19 cases, but this benefit does not yet appear in mortality models. Black race was an independent risk factor for increased COVID-19 cases and deaths. Thus, many proposed mechanisms through which Black race might increase risk for COVID-19, such as socioeconomic and healthcare-related predispositions, are inadequate in explaining the full magnitude of this health disparity.

Quantifying Patient Subpopulation Disparities in New Drugs and Biologics Approved Between 2007 and 2017.

Tufts CSDD conducted a study to quantify the magnitude of participant subgroup demographic disparities in industry-funded pivotal trials and establish baseline participant diversity measures. Eleven years of data on pivotal trials of all novel drugs and biologics approved between 2007 and 2017 (n = 341 drugs and n = 757 pivotal trials) was compiled and analyzed. The availability of reported participant demographic subgroup data was poor-most notably participant ethnicity with 63% of pivotal trials supporting all approved treatments missing data. The availability of data on participant race and ethnicity did not improve between 2007 and 2017. Participants of Black or of African Descent were the subgroup most highly under-represented. Three times as many participants in this demographic subgroup should have been enrolled in pivotal trials to achieve representation as dictated by disease prevalence rates and population census figures. Although variation was observed between disease conditions, under-representation of Black/African Descent participants occurred in nearly all conditions. Participants from indigenous communities were also highly under-represented. Asian participants were highly over-represented in pivotal trials. Approximately 14% more Hispanic/Latinx participants should have been enrolled in clinical trials to achieve population-proportional representation. The results suggest that participant demographic disclosure practices are falling short and that insufficient diversity in clinical trials is limiting the value of guidance on medical treatment dosing and response. The study findings supplement the FDA's Drug Trial Snapshot Reports and offer insight into the magnitude of, and trends in, participant demographic subgroup disparities.

Amenable Mortality and Neighborhood Inequality: An Ecological Study of São Paulo

This article uses an ecological study design to explore intraurban health inequality in São Paulo by examining neighborhood‐level changes in mortality amenable to medical care. We use 2003–2013 data for 95 city districts of São Paulo and apply a random coefficient growth curve modeling approach. We find that improved access to health‐care services is associated with reduced amenable mortality. Despite these overall improvements, the magnitude of population health disparities, as measured by amenable mortality, did not diminish. The effects of social, economic, and health system factors on amenable mortality depend on the income level of the district. Persistent disparities in amenable mortality within São Paulo suggests that neighborhood‐level differences in social determinants of health and access to health services require further investment from the Brazilian government.

P1706THE GRAFT SURVIVAL OF KIDNEY TRANSPLANTATION ACCORDING TO ETHNICITY IN KIDNEY TRANSPLANT RECIPIENTS

Abstract Background African American kidney transplant recipients experience disproportionately high rates of graft loss. The aim of this analysis was to use a UNOS data set that contains detailed baseline and longitudinal clinical data to establish and quantify the impact of the current overall graft loss definition on suppressing the true disparity magnitude in US AA kidney transplant outcomes. Methods Longitudinal cohort study of kidney transplant recipients using a data set created by United Network for Organ Sharing (UNOS), including 266,128 (African American 70,215, Non-African American 195,913) transplant patient between 1987 and December 2016. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression). Results 195,913 non-African American (AA) (73.6%) were compared with 70,215 AA (26.4%) recipients. 10-year-graft survival of AA in all era is lower than that of non-AA (31% in deceased kidney transplants (DKT) AA recipient and 42% in living kidney transplantation (LKT) non-AA recipient). 10-year-patient survival of AA with functioning graft in all era is similar that of non-AA. Multivariate Cox regression of factors associated with patient survival with functioning graft are acute rejection within 6 months, DM, hypertension and etc. Pre-transplant recipient BMI in AA show the trend as a protective factor in patient survival with functioning graft although not significantly in statistics Conclusions African American kidney transplant recipients experience a substantial disparity in graft loss, but not patient death with functioning graft.

Impact of age on racial disparity in early stage breast cancer in the United States.

e19058 Background: Racial disparities persists in women with early stage breast cancer and is most pronounced in Black (B) compared to White (W) women even when controlled for stage and biological subtype. Little is known about the impact of age on racial disparities. Our study evaluates the magnitude of a racial disparity in mortality across age strata in a real-world population. Methods: We identified stage I-III female breast cancer patients between 2010 – 2015 from the National Cancer Database. Hazard ratios (HR) and 95% Confidence Intervals (CI) for all-cause mortality were estimated using multivariable Cox Proportional Hazards regression, adjusted for clinical and demographic factors. The mortality risk for B and Other (O) race was compared to W across four age groups. To determine the significance in excess risk of mortality, the magnitude of disparity of each age group was compared to the > 60y age group. Results: A total of 679,327 patients were included. W comprised the largest percentage across all age groups. However, the percentage of W increased with age, while the percentage of B decreased with age (p < 0.001). The risk of mortality was significantly higher for B relative to W across all age groups ≤60y. When compared to > 60y, the magnitude of effect of age on risk of dying was significantly different (p < 0.0001) (Table). Conversely, the risk of mortality was significantly reduced for O race compared to W, with similar magnitude of effect across all ages. Conclusions: Even after adjusting for known risk factors of racial disparity such as insurance, biologic subtype and stage, the B to W racial disparity in mortality decreased with age (most pronounced in younger age) and appeared to diminish among women > 60 years of age. In contrast, the risk of dying in O race remained constant. Reasons are unclear and may be due to unmeasured socioecomomic or biologic factors that cannot be controlled for in this dataset. Regardless, identifying factors associated with worsened outcomes in younger age groups in B women should be the direction of future studies. [Table: see text]

Racial and Ethnic Disparities in Perinatal Process Measures [20C

INTRODUCTION: Racial disparities in obstetric outcome measures have been demonstrated in numerous studies. Disparities in process measures have yet to be subject to the same observation. This study aims to assess the magnitude of racial and ethnic disparities in perinatal process measures in a U.S. birth cohort. METHODS: A retrospective cohort study was conducted involving 58,280 singleton births (01/2017–3/2019) at 17 hospitals in the Northwest US. Process measures included antenatal steroids for births <34 weeks, late-preterm steroid administration for late preterm (34+0–36+6 weeks) births, timely treatment of severe hypertension, episiotomy, and prophylactic antibiotics for 3rd/4th degree laceration. Unadjusted odds ratios and 95% CIs were calculated by race or ethnicity, using white as the reference group. RESULTS: Compared to white women, Hispanic women were less likely to receive late preterm steroids if they delivered at 34–36 weeks (OR 0.56; 95% CI 0.44–0.71) and antibiotics for a 3rd/4th degree laceration (OR 0.48; 95% CI 0.25–0.92). Hispanic and African-American women were more likely to receive timely treatment for severe hypertension (OR 1.64; 95% CI 1.24–2.19 and OR 1.51; 95% CI 1.01–2.26, respectively). Nulliparous vaginal births in Asian/Pacific Islander women were more likely to have an episiotomy (OR 1.51; 95% CI 1.27–1.81). Antenatal steroid administration for births <34 weeks was similar across racial groups. CONCLUSION: This study demonstrates that disparities exist in obstetric process measures. A better understanding of why these disparities exist and their relation to outcome disparities is needed.

Updated National Estimates of Disparities in Physical Activity and Sports Participation Experienced by Children and Adolescents With Disabilities: NSCH 2016-2017.

Children and adolescents with disabilities often report low levels of physical activity (PA). Estimating the magnitude of PA disparities has been previously challenged by underreporting and variability in subsampling of disability. Using the National Survey of Children's Health, this study estimated the population-level PA disparities experienced and the association between disability status and PA engagement. Weighted prevalence of PA engagement (National Physical Activity Guidelines for Americans (2nd edition) and sports participation) was compared across disability groups for children (n = 20,867, 6-11y) and adolescents (n = 28,651, 12-17y) and found to be 12%. Age-stratified multivariable logistic regressions estimated the likelihood of PA engagement as a function of disability status and type, after adjusting for child and household factors. Children, but not adolescents, with disabilities had significantly lower odds of being sufficiently active compared with peers without disabilities (adjusted odds ratio = 0.75; 95% confidence interval, 0.60-0.94). Across age groups, the lowest prevalence rates were observed among those experiencing function and mobility disabilities. Children and adolescents were significantly less likely to participate in sports compared with peers. Children with function and mobility disabilities were identified as priority subpopulations least likely to be sufficiently active. The disparity in sports participation highlights a critical intervention point for increasing PA among children with disabilities.

Guideline-Concordant Treatment Among Elderly Women With HER2-Positive Metastatic Breast Cancer in the United States.

It is crucial to identify whether women with HER2-positive (HER2+) metastatic breast cancer (MBC) are treated according to treatment guidelines and whether treatment disparities exist. This study examined guideline-concordant treatment among women with HER2+ MBC and determined the magnitude of differences in treatment between those with positive and negative hormone receptor (HR) status using a nonlinear decomposition technique. A retrospective observational cohort study was conducted using the SEER-Medicare linked database. The study cohort consisted of women aged ≥66 years diagnosed with HER2+ MBC in 2010 through 2013 (n=241). Guideline-concordant initial treatment after cancer diagnosis was defined based on the NCCN Clinical Practice Guidelines in Oncology for Breast Cancer. A multivariable logistic regression was performed to identify significant predictors of guideline-concordant treatment. A postregression decomposition was conducted to identify the magnitude of disparities in treatment by HR status. Of 241 women included in the study, a total of 76.8% received guideline-concordant treatment. These women were significantly more likely to have positive HR status (P=.0298), have good performance status (P=.0009), and more oncology visits (P<.0001). With 1-year increments in age at cancer diagnosis, the likelihood of receiving guideline-concordant treatment reduced by 5% (P=.0356). The decomposition analysis revealed that 19.0% of the disparity in guideline-concordant treatment between women with positive and negative HR status was explained by differences in their characteristics. Enabling characteristics (marital status, income, and education) explained the highest (22.8%) proportion of the disparity. Nearly one-quarter of the study cohort did not receive guideline-concordant treatment. Our findings suggest opportunities to improve cancer care for elderly women with negative HR status who are unpartnered or have lower socioeconomic status. The high unexplained portion of the disparity by HR status can be due to patient treatment preferences, propensity to seek care, and organizational and physician-level characteristics that were not included in the study.

Complex interactions underlie racial disparity in the risk of developing Alzheimer's disease dementia.

We aim to determine racial disparities and their modifying factors in risk for Alzheimer's disease (AD) dementia among cognitively normal individuals 65 years or older. Longitudinal data from the National Alzheimer's Coordinating Center Uniform Data Set on 1229 African Americans (AAs) and 6679 whites were analyzed for the risk of AD using competing risk models with death as a competing event. Major AD risk factors modified racial differences which, when statistically significant, occurred only with older age among APOE ε4 negative individuals, but also with younger age among APOE ε4 positive individuals. The racial differences favored AAs among individuals with body mass index (BMI)<30, but whites among individuals with a high BMI (≥ 30), and were additionally modified by sex, education, hypertension, and smoking status. The presence, direction, and relative magnitude of racial disparity for AD represent an interactive function of major AD and cerebrovascular risk factors.

Do Racial and Ethnic Disparities in Mental Health Treatment Vary With Underlying Mental Health?

A long line of studies document substantial and persistent racial and ethnic disparities in the use of mental health services. Many recent studies follow the Institute of Medicine's definition of disparities, adjusting only for differences in health and mental health status across groups. However, controlling for mental health may mask important changes in the magnitudes of disparities at different levels of mental health need. We extend the previous literature by explicitly estimating how differences in treatment use across groups change at different levels of psychological distress. We used detailed data on sociodemographic characteristics, health insurance coverage, treatment, and the K6 psychological distress scale from the 2010 to 2015 Medical Expenditure Panel Survey to estimate nonlinear models of ambulatory and prescription drug mental health treatment. We find that in contrast to physical health treatment, Black-White and Hispanic-White disparities in any mental health treatment use widen with higher levels of psychological distress.

Differential winter and breeding range shifts: Implications for avian migration distances

AbstractAimFor many migratory avian species, winter and breeding habitats occur at geographically distinct locations. Disparate magnitudes and direction of shifts in wintering and breeding locations could lead to altered migration distances. We investigated how shifts in the centre of abundance (COA) of winter and breeding ranges have changed for 77 species of short‐distance migratory birds. We addressed whether species tracked their historical average temperature and precipitation conditions at their winter and breeding COA, using data from 1990 to 2015.LocationNorth America.MethodsWe calculated the COA for winter and breeding ranges from the National Audubon Society's Christmas Bird Count and the North American Breeding Bird Survey. We regressed the annual change in distance (km) between the two annual COAs of each species as a proxy for change in migration distance. We constructed a series of generalized linear mixed models (GLMMs) to evaluate changes in average temperature and precipitation at the wintering and breeding COAs.ResultsWinter shifts in COA were predominantly northward. For most species, average temperature and precipitation that species experienced had not changed. Breeding shifts in COA varied in direction. For breeding season COAs, average temperature warmed, but average precipitation had not changed. Thirty‐one species significantly decreased their migration distances, mainly driven by northward shifts in the winter range. Ten species increased their migration distances.Main conclusionsWinter and breeding range shifts in COA have not occurred at the same magnitude and direction and have therefore impacted migration distance. Our results suggest that wintering and breeding range shifts occur independently and under different climate pressures.