non-Hispanic Blacks Research Articles

Culture and Patient-Provider Trust Among People with HIV: Psychometric Properties of the HCR Trust Scale-Revised in Haitian Creole and Spanish.

Patient-provider trust is associated with optimal HIV care engagement and ART adherence. However, cross-cultural examination of trust in providers in this diverse population is limited. The current study examines data from 1272 Miami-Dade County Ryan White Program clients. Study objectives were to explore the psychometric properties of the HCR Trust Scale-Revised translated inHaitian Creole and Spanishand to evaluate similarities and differences in responses to the HCR Trust Scale-Revised across Non-Hispanic Black, Haitian, and Hispanic participants and the English, Haitian Creole, and Spanishtranslations of the scale. Results indicated that the HCR Trust Scale-Revised has a single structure with good reliability for all groups except Haitian participants, for which response patterns were characterized by low variance and high endorsement of alternative response options. We draw on previous literature examining patient-provider experiences to discuss the importance of considering culture in the measurement of patient-provider trust.

Nationwide Cross-Sectional Analysis of Mortality Trends in Patients with Sarcoidosis and Non-Ischemic Cardiovascular Disease—The Impact of Gender, Ethnicity, Geographical Location, and COVID-19 Pandemic

Background and Objectives: The epidemiological data regarding mortality rates of adults with sarcoidosis and non-ischemic cardiovascular disease (CVD) are limited. A retrospective observational analysis was conducted to identify trends and disparities related to sarcoidosis and non-ischemic cardiovascular disease mortality among the adult US population from 1999 to 2022. Methods: We used the Centers for Disease Control and Prevention (CDC) WONDER database to extract death certificate data for the adult US population (≥25 years). The age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and annual percent changes (APCs) were determined using Joinpoint. Results: Between 1999 and 2022, 23,642 deaths were identified related to non-ischemic CVD + sarcoidosis. The overall AAMR increased from 0.2 (95% CI, 0.2 to 0.3) in 1999 to 0.5 (95% CI, 0.5 to 0.6) in 2022. Females had a higher AAMR than males (0.6 vs. 0.5). Non-Hispanic (NH) blacks had the highest AAMR, followed by NH whites and Hispanic or Latinos. The southern region had the highest AAMR (0.7: 95% CI, 0.6–0.7), followed by the Midwest (0.6, 95% CI, 0.54–0.669), the Northeast (0.5, 95% CI, 0.5 to 0.6), and the West (0.4; 95% CI, 0.3–0.4). Urban and rural areas had comparable mortality rates (0.5 vs. 0.6). People aged 65+ had the highest AAMRs. Conclusions: The overall mortality rates for non-ischemic CVD and sarcoidosis have increased in the US from 1999 to 2022. Females and NH blacks had higher AAMRs, while a minimal variation was observed based on geographical regions. Early diagnosis and prompt management are the keys to reducing the mortality burden of non-ischemic CVD plus sarcoidosis.

Voting Restrictions and Increased Odds of Adverse Birth Outcomes in the US.

Disparities persist in adverse birth outcomes - preterm birth and small-for-gestational age (SGA) among racialized populations. Previous studies have indicated that voting restrictions are associated with health outcomes, such as access to health insurance and teenage birth rates. This paper examines whether the association between voting restrictions and adverse birth outcomes varies according to birthing individuals' race/ethnicity. These analyses merged individual-level 2019-2020 Pregnancy Risk Assessment Monitoring System (PRAMS, 8th edition) data with state-level exposure information. The exposure, the Cost of Voting Index (COVI), is a 2020 state-level measure of voting restrictions, and the outcomes were preterm birth and SGA. Multilevel logistic regression, survey-weighted models adjusted for sociodemographic and geographically-based characteristics. Subanalyses examined if the association differed by race (non-Hispanic White, non-Hispanic Black, Hispanic, API, Other). In the unadjusted model, a standard deviation increase in COVI was associated with increased odds of preterm birth (OR = 1.11, 95% CI = 0.98, 1.25) and SGA (OR = 1.12, 95% CI = 1.02, 1.22). The association for SGA was still significant in the fully adjusted models. Results differed by race/ethnicity with the largest effects among API (OR = 1.20, 95% CI = 0.95, 1.52) for preterm birth and OR = 1.27, 95% CI = 1.01, 1.59) for SGA respectively). Our results suggest structural voting barriers disproportionately increase the odds of adverse birth outcomes, especially for API-birthing individuals. Increasing voting restrictions may amplify existing birth inequities.

Race and ethnicity dynamics in survival to 100 years in the United States.

After age 85, the U.S. non-Hispanic Black population mortality rate becomes less than that of the White population (called the Black-White mortality crossover). It is not known how this survival advantage compares to Asian and Hispanic groups, and whether differences persist to age 100+ years. The U.S. period life table data were extracted to obtain life expectancy at birth and at ages 70, 85, and 100 years according to year, sex, and race and ethnicity. Age-specific death rates and adult modal age at death were calculated. We computed period probabilities of survival to age 100, from ages 70, 80, and 90. Pseudo-birth cohort calculations were undertaken to enable comparison with period-based results. In 2019, the Black-White mortality crossover occurred at 86-88 years and persisted at ages 100 and 100+. Life expectancies at age 100 for non-Hispanic Black, Hispanic, and Asian populations were similar and were significantly greater than the non-Hispanic White population. From 2006 to 2019, the probability of survival from 70 and 80 years to age 100 was highest for the Hispanic population, followed by non-Hispanic Black and then non-Hispanic White populations. Probability of survival from age 90 to 100 years was similar for all but the non-Hispanic White population, which had a comparatively lower probability of survival. When Asian population data became available in 2019, this population had the highest probability of survival to age 100, starting from ages 70, 80, and 90 years. Pseudo-cohort results displayed patterns consistent with those observed over calendar years. Race- and ethnicity-based variation in mortality between ages 85 and 100+ years suggests differences in environmental and possibly genetic influences upon risk for exceptional longevity.

Community Disparities in Out-of-Hospital Cardiac Arrest Prehospital Antiarrhythmic Practices

ABSTRACT OBJECTIVES Antiarrhythmic administration is an important treatment for out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, but little is known about disparities in such antiarrhythmic practices. We sought to investigate the association between community race/ethnicity and prehospital antiarrhythmic administration for OHCA. METHODS We conducted a retrospective study of a national prehospital database, NEMSIS, linked to Census data. We included OHCAs with a shockable rhythm from 2018-2021. We stratified patients based on majority (>50%) ZIP code race/ethnicity (non-Hispanic White (White), non-Hispanic Black (Black), and Hispanic/Latino). We then created two cohorts: 1) patients with a shockable rhythm at any point to study differences in antiarrhythmic administration rates, and 2) patients with an initial shockable rhythm to analyse differences in time to antiarrhythmic administration. For patients with a shockable rhythm at any point, we used logistic regressions to evaluate the association of community race to antiarrhythmic administration. For patients with an initial shockable rhythm, we compared the time from EMS dispatch to the first antiarrhythmic administration. RESULTS Of 763,944 cardiac arrests, 255,875 had a shockable rhythm during the OHCA, and 139,581 had an initial shockable rhythm. For patients with a shockable rhythm at any point, majority White (33.0%) received antiarrhythmics at a higher rate than majority Black (28.9%; aOR 0.9, 95% CI 0.8-0.9) and majority Hispanic/Latino (27.8%; aOR 0.8 95% CI 0.7-0.8). For patients with an initial shockable rhythm, the time to antiarrhythmic for White (median 19.6, IQR 15.0-26.3 minutes) was lower than for Black (median 20.5 minutes, IQR 16.3-26.4, p < 0.01) but higher than Hispanic/Latino (median 18.0 minutes, IQR 14.3-23.4, p < 0.01). CONCLUSIONS While antiarrhythmic administration rate was lower for minority communities and time to antiarrhythmic was higher for Black OHCAs, time to antiarrhythmic administration was lower for Hispanic/Latino OHCAs.

Sleep disturbances and racial-ethnic disparities in 10-year dementia risk among a national sample of older adults in the USA.

Race/ethnicity and sleep disturbances are associated with dementia risk. To explore racial-ethnic disparities in sleep disturbances, and whether race/ethnicity moderates the relationship between sleep disturbances and dementia risk among older adults. We analysed ten annual waves (2011-2020) of prospective cohort data from the National Health and Aging Trends Study, a nationally representative USA sample of 6284 non-Hispanic White (n = 4394), non-Hispanic Black (n = 1311), Hispanic (n = 342) and non-Hispanic Asian (n = 108) community-dwelling older adults. Sleep disturbances were converted into three longitudinal measures: (a) sleep-initiation difficulty (trouble falling asleep within 30 min), (b) sleep-maintenance difficulty (trouble falling asleep after waking up early) and (c) sleep medication usage (taking medication to sleep). Cox proportional hazards models analysed time to dementia, after applying sampling weights and adjusting for sociodemographic characteristics and health. Black, Hispanic and Asian respondents exhibited higher frequencies of sleep-initiation and sleep-maintenance difficulties, but had less sleep medication usage, compared with White older adults. Among Hispanic respondents, sleep-initiation difficulty was associated with significantly decreased dementia risk (adjusted hazard ratio (aHR) = 0.34, 95% CI 0.15-0.76), but sleep-maintenance difficulty was associated with increased dementia risk (aHR = 2.68, 95% CI 1.17-6.13), compared with White respondents. Asian respondents using sleep medications had a significantly higher dementia risk (aHR = 3.85, 95% CI 1.64-9.04). There were no significant interactions for Black respondents. Sleep disturbances are more frequent among older Black, Hispanic and Asian adults, and should be considered when addressing dementia disparities. Research is needed to explore how certain sleep disturbances may elevate dementia risk across different racial and ethnic subgroups.

Respiratory syncytial virus vaccination among US adults aged ≥60 years

BackgroundRespiratory syncytial virus (RSV) vaccines have been recommended for US adults aged ≥60 years for nearly one year. However, the extent of vaccination coverage and the factors influencing uptake remain underexplored. This study aimed to evaluate national and state-specific RSV vaccination coverage among US adults aged ≥60 years and to identify demographic and socioeconomic factors that influence vaccination uptake.MethodsThis cross-sectional study analyzed data from the US Census Household Pulse Survey, from January 9 to March 4, 2024, which included 49,322 adults aged ≥60 years. Participants self-reported their RSV vaccination status along with demographic and socioeconomic information. Multivariable Poisson regression was used to identify factors associated with vaccination uptake.ResultsAs of March 4, 2024, RSV vaccination coverage among US adults aged ≥60 years was estimated at 22.2% (95% CI, 21.6%-22.7%). State-specific vaccination coverage ranged from 12.4% in Mississippi to 33.1% in Colorado. Coverage was higher in older age groups, with 21.2% among those aged 65-69 years, 28.1% among 70-74 years, 31.9% among 75-79 years, and 30.2% among those aged ≥80 years, compared to 10.8% among those aged 60-64 years. Racial/ethnicity disparities were evident, with lower coverage among Hispanics (18.3%) and non-Hispanic Blacks (17.6%) compared to non-Hispanic Whites (23.3%). Coverage was similar between males (22.6%) and females (21.8%). Factors positively associated with vaccination included older age, higher education level, higher household income, unemployment, and residing in the Midwest or West. Conversely, being non-Hispanic Black, uninsured, experiencing financial difficulties, and lack of COVID-19 vaccination were associated with reduced likelihood of receiving the RSV vaccine.ConclusionsDuring the first RSV season after the recommendations for RSV vaccination in US adults aged ≥60 years, uptake shows promise but is marked by significant disparities related to race/ethnicity, socioeconomic status, and geographic location. Efforts to address these disparities are crucial to enhance vaccination coverage and reduce the impact of RSV on this vulnerable population.

Racial and Ethnic Disparities in Failure-to-Rescue After Postoperative Sepsis After Noncardiac Surgery.

Sepsis disproportionately affects marginalized communities. This study aims to evaluate racial and ethnic disparities in failure-to-rescue (FTR) after postoperative sepsis. This cross-sectional study used data from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent inpatient noncardiac surgery between 2018 and 2021. Patients were categorized as non-Hispanic White (hereafter, White), non-Hispanic Black (hereafter, Black), Asian, and Hispanic individuals. The association between (1) FTR after sepsis and (2) FTR after septic shock and race and ethnicity was evaluated using multivariable logistic regression. Failure-to-rescue was defined as 30-day mortality among patients who developed postoperative sepsis or postoperative septic shock. Among the 1388,977 patients (mean [SD] age 60.5 [16]); 783,056 (56.4%) were female, 1017,875 (73%) were White, 171,774 (12%) were Black, 138,457 (10%) were Hispanic, and 60,871 (4%) were Asian. Compared to White individuals, Black (adjusted odds ratio [aOR], 1.29; 95% CI, 1.23-1.35, P < .001) and Hispanic individuals (aOR, 1.15; 95% CI, 1.09-1.21, P < .001) were more likely to develop sepsis; Black individuals were more likely to develop septic shock (aOR, 1.28; 95% CI, 1.21-1.36; P < .001), and Asians were less likely to develop septic shock (aOR 0.84; 95% CI, 0.75-0.93, P = .002). Black individuals experienced lower rates of FTR after sepsis [Black: (aOR, 0.71; 95% CI, 0.54-0.94; P = .017), while Black (aOR, 0.93; 95% CI, 0.80-1.08; P = .35)], Hispanic (aOR, 0.87; 95% CI, 0.72-1.06; P = .16) and Asian Individuals (aOR, 1.06; 95% CI, 0.8-1.37; P = .67) experienced similar rates of FTR after septic shock compared to White individuals. Black and Hispanic individuals experienced higher rates of postoperative sepsis but did not experience higher rates of failure-to-rescue. Reducing inequity in surgical care should focus on efforts to prevent postoperative sepsis.

Racial and ethnic disparities in patients with severe tricuspid regurgitation: The Bronx-Valve registry.

Severe tricuspid regurgitation (TR) is an adverse prognostic factor. The presence of potential racial/ethnic disparities in patient characteristics and outcomes remain unexplored. This study aimed to investigate the impact of race/ethnicity on the clinical course of severe TR. We conducted a retrospective cohort analysis of all adults diagnosed with severe TR between January 2017 and December 2019 at a quaternary-care health system. Clinical and echocardiographic features were evaluated according to race/ethnicity. TR was categorized into four etiologies: primary, cardiac implantable electronic device-induced, ventricular secondary (V-STR), and atrial secondary TR. V-STR subgroups included left-sided cardiac disease and pulmonary hypertension. The primary endpoint was 5-year all-cause mortality, with secondary endpoints being heart failure hospitalization (HFH) and cardiovascular (CV) mortality. A total of 989 patients were analyzed: 47.8 %, 35.1 %, and 17.1 % were non-Hispanic Black, Hispanic, and non-Hispanic White, respectively, over a median follow-up of 14.8 (3-42.4) months. The mean age was 71.4 ± 15.6 years (60.9 % women) with non-Hispanic Black and Hispanic patients younger yet displaying higher comorbidity burden, worse functional class, and more pronounced right ventricular remodeling. Left-sided cardiac disease was the predominant etiology (65.9 %), with a higher prevalence among non-White individuals. All-cause mortality and CV mortality occurred in 575 (58.1 %) and 196 (19.8 %) of patients with no significant differences among groups. HFH presented in 334 (33.1 %) of patients with Black patients having an increased risk compared to White individuals (HR, 1.45; 95 %CI, 1.04-2.02). At the time of severe TR detection, Black and Hispanic patients, despite being younger, had higher comorbidities and more advanced disease than White patients. While 5-year mortality rates showed no significant racial/ethnic differences, Black patients had a higher risk of HFH.

Association of racism experience with gun purchase during COVID-19: Evidence from a national survey in the United States

ObjectiveConcurrent with a substantial surge in gun purchases among Americans during COVID-19, there was an escalation of racism and hate crimes in the United States. Despite this disturbing trend, little is known about whether and the extent to which racism experience is linked to gun purchase during the pandemic. This study aims to examine the association between experience of racial discrimination and gun purchase among Americans during COVID-19. MethodsBased on data from the Health, Ethnicity, and Pandemic Survey (n = 2,584), a national survey conducted in the U.S. in October 2020, chi-square tests and logistic regressions were estimated to examine the association between racism experience and gun purchase during COVID-19 with and without controlling for selected covariates. ResultsAbout 6.9 % of the sample reported gun purchases during COVID-19. Among respondents who reported experience of racism, 18.3 % purchased a gun as compared to 5.8 % among those who did not report experience of racism. Relative to respondents with no experience of racism, the odds of gun purchase for those who reported racism experience became 257 % as much (AOR = 2.57, 95 % CI: 1.63, 4.04) after controlling for other covariates in the analysis. Non-Hispanic Blacks were more likely to report gun purchases than non-Hispanic Whites (AOR = 1.80, 95 % CI: 1.04, 3.10). ConclusionsAmericans who reported experience of racism during COVID-19 were far more likely to purchase a gun than those otherwise. These findings elevate the need for addressing racism as an important risk factor of firearm violence.

Acceptability of Long-Acting Cabotegravir + Rilpivirine in a Large, Urban, Ambulatory HIV Clinic.

Outside of randomized controlled trials (RCTs), there are limited data regarding the acceptability of injectable long-acting cabotegravir + rilpivirine (LA-CAB+RPV) among persons living with HIV (PLWH). To evaluate acceptability, we describe participant-reported outcomes (PRO) of LA-CAB+RPV among a population underrepresented in RCTs. Ruth M. Rothstein Core Center (CORE), large urban HIV clinic in Chicago, Illinois, USA. We interviewed PLWH prescribed LA-CAB+RPV who receive primary care at CORE. PRO endpoints included treatment satisfaction, tolerability of injections, reasons for switching to LA-CAB+RPV, and unexpected effects of LA-CAB+RPV. Mean and standard deviations (mean±SD) and proportions (%) are reported. Among respondents (N=150), 67% identified as Non-Hispanic Black, 24% Hispanic, 56% male; the average age was 43 years (SD:13.2), and 37% were ≥50 years old. Most respondents (93%) completed ≥3 injection appointments at the time of interview. The most common reasons for switching to LA-CAB+RPV were no longer wanting to take pills (89%) and trouble taking their pills daily (58%). Treatment satisfaction was high (6.7±0.5 out of 7). Two-thirds (61%) reported an unexpected aspect of their life improved. Pain from injections was common (98%), with a mean pain score of 4.3 out of 10. Among those reporting pain, half (47%) reported pain decreased after initial injection. Among participants reporting pain score >6 (n=36), most (78%) reported no improvement since initial injection. We found high treatment satisfaction with LA-CAB+RPV in a diverse population. Participants reported moderate injection pain, which improved with time. Results suggest injectable LA-CAB+RPV will be met with acceptability across diverse participant populations.

Prostate cancer incidence rates, trends, and treatment related to prostate-specific antigen screening recommendations in the United States

BackgroundChanges in US prostate-specific antigen (PSA) screening guidelines have impacted prostate cancer (PCa) incidence rates and trends. This study shows corresponding changes in PCa incidence rates and describes treatment patterns by tumor stage, age, and race/ethnicity. MethodsAnalyses were based on 777,152 cases diagnosed in 17 population-based tumor registries in the SEER Program of the US National Cancer Institute, 2007–2021. Rates were age adjusted and trends assessed using annual percent change and joinpoint regression. ResultsPCa age-adjusted incidence rates (per 100,000) fell from 165.8 in 2007 to 101 in 2014 (APC=-6.51, p<0.05) and then rose to 121.2 in 2021 (APC=1.87, p< 0.05). The significant fall and rise in rates appeared in ages 55–69 and ≥70, all racial/ethnic groups (except in Hispanics during 2014–2021), and in local/regional stage. PCa incidence rates by tumor stage, age, and race/ethnicity were presented and discussed. A few PCa cases were identified through autopsy or death certificate among the racial/ethnic groups (0.68 %-1.37 %). Unstaged cases identified through sources other than autopsy or death certificate significantly varied by race/ethnicity, ranging from 4.13 % for non-Hispanic (NH) Whites to 9.5 % for Hispanic (Chi-square p <.0001). In 2017–2021, surgery occurred in 33 % of cases (primarily in local/regional cases, inversely associated with age), radiation in 30 % of cases (increasing with age in local/regional stage cases and decreasing with age in distant stage cases), and chemotherapy in 2 % of cases (<1 % in local/regional stage cases and 9 %-38 % for age groups in distant stage cases). Several racial/ethnic differences in treatment exist, such as NH Blacks (vs. NH Whites) with local/regional disease were significantly less likely to receive surgery and more likely to receive radiation. ConclusionsUnderstanding trends and patterns of PCa rates and treatment among patients by tumor stage, age, and race/ethnicity can guide public health planning in relation to screening and treatment.

Neighborhood demographics in relation to marketing and regulation-related factors among cannabis retailers in 5 US cities

ObjectivesThis study assessed differences in cannabis retailer practices by neighborhood sociodemographics, which can inform disparity-relevant interventions. MethodsMultilevel multivariable logistic regressions examined retailers’ census tract demographics (percent <21 years-old; non-Hispanic White, Black, or other race, Hispanic; median household income [MHHI]) in relation to 2022 audit data regarding marketing (youth-oriented signs, health-claims, exterior ads, price specials, membership programs, delivery/pick-up) and regulatory compliance (pregnancy and health-risk warning signage, exterior minimum-age signage) among 150 randomly-selected retailers in 5 US cities/states (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Results20.7% had youth-oriented signage, 28.7% health-claim signage, 27.3% exterior ads, 75.3% price specials, 39.3% membership programs, 28.0% delivery/pick-up, 72.0% pregnancy warnings, 38.0% health-risk warnings, and 64.0% minimum-age signage. Retailers in tracts with higher percent <21 and non-Hispanic White had lower odds of youth-oriented signage. Higher MHHI had higher odds of health-claims; higher percent Hispanic had lower odds of health-claims. Higher MHHI had lower odds of exterior ads. Higher percent <21 had lower odds of price specials. Higher percent non-Hispanic White had higher odds of membership programs. Higher percent non-Hispanic White, other race, and Hispanic had higher odds of delivery/pick-up; higher MHHI had lower odds of delivery/pick-up. Higher percent non-Hispanic White had higher odds of pregnancy warnings. Higher percent <21 had lowers odds of health-risk warnings. Demographics were unrelated to minimum-age signage. ConclusionsGiven key findings (e.g., lower compliance in racial/ethnic minority communities), cannabis retail could exacerbate disparities, underscoring the need for related regulatory and prevention efforts.

Smoking behavior and social identity: Correlates of Phantom Smoking Among Lesbian, Gay, Bisexual, Transgender, and Other Sexual and Gender Diverse Young Adults.

LGBTQ+ populations and people who smoke face stigma. This may lead to distancing oneself from smoking-related stigma by becoming phantom smokers (i.e., reporting smoking, but not identifying as a smoker). We explored correlates of phantom cigarette smoking among LGBTQ+ young adults. Participants were U.S. young adults (18 to 24 years) who identified as LGBTQ+, reported any past 30-day cigarette smoking and had a valid response for smoker self-identification (unique N= 5,545). We incorporated data from participants who completed one or more of the seven surveys from FDA's This Free Life campaign evaluation (February 2016-July 2019). Multivariable panel regression models with unweighted data examined phantom smoking correlates. Over 60% of the sample were phantom smokers. Compared with self-identified smokers, phantom smokers were younger, more likely to be gay men than lesbian/gay women, and more likely to be non-Hispanic White than non-Hispanic Black, Hispanic or non-Hispanic people of other races/ethnicities. Phantom smokers were more likely to have a college plus education (vs. high school or less) and report past 30-day alcohol use. Phantom smokers smoked on fewer of the past 30 days and were less likely to report positive cessation attitudes, nicotine dependence, and current e-cigarette or other tobacco product use. This is the first known study to explore factors associated with phantom smoking among LGBTQ+ young adults. Over half of young adult smokers were phantom smokers. Tobacco education for LGBTQ+ populations should consider phantom smoking and cessation implications to tailor content for phantom and self-identified smokers. We examined predictors of phantom smoking (current smoking but denying smoker identity) among LGBTQ+ young adult smokers, which has not yet been explored among this population. Phantom (vs. self-identified) smokers were less likely to be lesbian/gay women (vs. gay men) or from a racial/ethnic minority group and more likely to report past 30-day alcohol use. Phantom smokers reported less tobacco use, lower nicotine dependence, and less favorable cessation attitudes. Phantom smokers comprised most smokers in our sample. Findings suggest the importance of addressing this unique aspect of LGBTQ+ smoking in research, clinical settings, and tailored tobacco public education messages.

Gender and Racial/Ethnic Disparities in HIV Care and Viral Suppression at Jail Entry.

Women and racial/ethnic minorities living with HIV are less likely than White men to be engaged in HIV treatment when entering US jails. Few studies have examined the intersection of gender and race/ethnicity among incarcerated populations. The "Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative" (EnhanceLink) was a 10-site prospective cohort study of 1,270 people living with HIV in correctional facilities between 2008 and 2011. Using data from this study (N = 1,096), we assessed the likelihood of having a usual source of HIV care, utilizing ART, and viral suppression (HIV-1 RNA < 200 copies/ml) within 30days of incarceration among the following groups, stratified by current gender and race/ethnicity, relative to non-Hispanic White men: Non-Hispanic Black women, non-Hispanic Black men, Hispanic/Latina (Hispanic) women, Hispanic men, and non-Hispanic White women. Compared to non-Hispanic White men, non-Hispanic Black women were 20% less likely to report that they had access to HIV care before incarceration after adjusting for age, sexual orientation, incarceration history, and medical comorbidities (prevalence ratio (PR) = 0.8, 95% CI: 0.7-0.9, p = 0.0002). Non-Hispanic Black, Hispanic, and Non-Hispanic White women were 30% less likely to utilize ART (respectively) than White men after adjusting for the same potential confounders (PR = 0.7, 95% CI: 0.6-0.9, p = 0.002; PR = 0.7, 95% CI: 0.5-0.9, p = 0.02; PR = 0.7, 95% CI: 0.5-1.0, p = 0.03). Our findings underscore the importance of culturally informed, community-based HIV interventions that promote equitable access to HIV care.

Merkel Cell Carcinoma and Immunosuppression, UV Radiation, and Merkel Cell Polyomavirus

Merkel cell carcinoma (MCC) is a rare but aggressive skin cancer. Quantifying the contribution of major potentially modifiable risk factors to the burden of MCC may inform prevention efforts. To estimate the population attributable fraction of MCC cases in the US that were attributable to major immunosuppressing conditions (eg, HIV, solid organ transplant, chronic lymphocytic leukemia [CLL]), ambient UV radiation [UVR] exposure, and Merkel cell polyomavirus [MCPyV]). This epidemiological assessment combined data from population-based registries and case series and included cases of MCC that were diagnosed from January 2001 to December 2019 diagnosed in people with HIV, solid organ transplant recipients, and patients with CLL who were identified through population-based cancer registries and linkages with HIV and transplant registries. UVR-based on cloud-adjusted daily ambient UVR irradiance was merged with cancer registry data on the county of residence at diagnosis. Studies reporting the prevalence of MCPyV in MCC specimens collected in the US were combined via a meta-analysis. HIV, solid organ transplant, CLL, UVR, and MCPyV. Population attributable fraction of MCC cases attributable to major risk factors. A total of 38 020 MCCs were diagnosed in the US among xx patients (14 325 [38%] female individuals; 1586 [4%] Hispanic, 561 [1%] non-Hispanic Black, and 35 171 [93%] non-Hispanic White individuals). Compared with the general US population, MCC incidence was elevated among people with HIV (standardized incidence ratio [SIR], 2.78), organ transplant recipients (SIR, 13.1), and patients with CLL (SIR, 5.75). Due to the rarity of these conditions, only 0.2% (95% CI, 0.1%-0.3%) of MCC cases were attributable to HIV, 1.5% (95% CI, 1.4%-1.7%) to solid organ transplant, and 0.8% (95% CI, 0.5%-1.3%) to CLL. Compared with individuals of racial and ethnic minority groups, MCC incidence was elevated among non-Hispanic White individuals at lower and higher ambient UVR exposure levels (incidence rate ratios: 4.05 and 4.91, respectively, for MCC on the head and neck). Overall, 65.1% (95% CI, 63.6%-66.7%) of MCCs were attributable to UVR. Based on a meta-analysis of 19 case series, 63.8% (95% CI, 54.5%-70.9%) of MCCs were attributable to MCPyV. Studies were identified from a MEDLINE search performed on October 12, 2023. The results of this study suggest that most MCC cases in the US were attributable to ambient UVR exposure or MCPyV, with a small fraction due to immunosuppressive conditions. Efforts to lower MCC incidence could focus on limiting UVR exposure.

Marital status, brain health, and cognitive reserve among diverse older adults.

Being married may protect late-life cognition. Less is known about living arrangement among unmarried adults and mechanisms such as brain health (BH) and cognitive reserve (CR) across race and ethnicity or sex/gender. The current study examines (1) associations between marital status, BH, and CR among diverse older adults and (2) whether one's living arrangement is linked to BH and CR among unmarried adults. Cross-sectional data come from the Washington Heights-Inwood Columbia Aging Project (N = 778, 41% Hispanic, 33% non-Hispanic Black, 25% non-Hispanic White; 64% women). Magnetic resonance imaging (MRI) markers of BH included cortical thickness in Alzheimer's disease signature regions and hippocampal, gray matter, and white matter hyperintensity volumes. CR was residual variance in an episodic memory composite after partialing out MRI markers. Exploratory analyses stratified by race and ethnicity and sex/gender and included potential mediators. Marital status was associated with CR, but not BH. Compared to married individuals, those who were previously married (i.e., divorced, widowed, and separated) had lower CR than their married counterparts in the full sample, among White and Hispanic subgroups, and among women. Never married women also had lower CR than married women. These findings were independent of age, education, physical health, and household income. Among never married individuals, living with others was negatively linked to BH. Marriage may protect late-life cognition via CR. Findings also highlight differential effects across race and ethnicity and sex/gender. Marital status could be considered when assessing the risk of cognitive impairment during routine screenings.

Attributing Racial Differences in Care to Health Plan Performance or Selection

There is increased interest in public reporting of, and linking financial incentives to, the performance of organizations on health equity metrics, but variation across organizations could reflect differences in performance or selection bias. To assess whether differences across health plans in sex- and age-adjusted racial disparities are associated with performance or selection bias. This cross-sectional study leveraged a natural experiment, wherein a southern US state randomly assigned much of its Medicaid population to 1 of 5 plans after shifting to managed care in 2012. Enrollee-level administrative claims and enrollment data from 2011 to 2015 were obtained for self-identified Black and White enrollees. The analyses were limited to Black and White Medicaid enrollees because they accounted for the largest percentages of the population and could be compared with greater statistical power than other groups. Data were analyzed from June 2021 to September 2024. Plan enrollment via self-selection (observational population) vs random assignment (randomized population). Annual counts of primary care visits, low-acuity emergency department visits, prescription drug fills, and total spending. For observational and randomized populations, models of each outcome were fit as a function of plan indicators, indicators for race, interactions between plan indicators and race, and age and sex. Models estimated the magnitude of racial differences within each plan and tested whether this magnitude varied across plans. Of 118 101 enrollees (mean [SD] age, 9.3 [7.5] years; 53.0% female; 61.4% non-Hispanic Black; and 38.6% non-Hispanic White), 70.2% were included in the randomized population, and 29.8% were included in the observational population. Within-plan differences in primary care visits, low-acuity emergency department visits, prescription drug use, and total spending between Black and White enrollees were large but did not vary substantially and were not statistically significantly different across plans in the randomized population, suggesting minimal effects of plans on racial differences in these measures. In contrast, in the observational population, racial differences varied substantially across plans (standard deviations 2-3 times greater than in the randomized population); this variation was statistically significant after adjustment for multiple testing, except for emergency department visits. Greater between-plan variation in racial differences in the observational population was only partially explained by sampling error. Stratifying by race did not bring observational estimates of plan effects meaningfully closer to randomized estimates. This cross-sectional study showed that selection bias may mischaracterize plans' relative performance on measures of health care disparities. It is critical to address disparities in Medicaid, but adjusting plan payments based on disparity measures may have unintended consequences.

Impact of Insurance Status on Postoperative Recovery after Microsurgical Breast Reconstruction.

Persistent disparities in breast reconstruction access have been widely documented, yet a significant research gap remains in understanding the impact of social determinants of health (SDOH) on postoperative outcomes and complications. A retrospective chart review was performed on all patients who underwent abdominal-based free-flap breast reconstruction between August 2018 and December 2022 at a racially, ethnically, and socioeconomically diverse urban academic institute with a historically underserved patient population. Patients were stratified by the public (Medicare and Medicaid) versus private insurance as a proxy for SDOH. Patient demographics, length of stay (LOS), timing in progression through postoperative recovery milestones, and complications were compared. A total of 162 patients were included, and 57% of patients had public insurance, with this group more likely to be Hispanic (odds ratio [OR] 2.7; p = 0.003) and Spanish-speaking (OR 3.4; p = 0.003). Privately insured patients were more likely to be non-Hispanic Black (OR 2.7; p = 0.006). Patients with public insurance had a higher rate of unplanned return to the operating room within 90 days and a higher incidence of complications, though not statistically significant. They also experienced a significantly longer LOS than privately insured patients (3.6 ± 1.0 vs. 3.0 ± 0.7 days; p < 0.0001). Logistic regression identified an LOS exceeding 3 days as independently associated with public insurance status (OR 3.0; p = 0.03), bilateral procedure (OR 5.6; p = 0.0007), preoperative functional-dependent status (OR 7.0; p = 0.04), and higher body mass index (BMI; OR 1.1; p = 0.03). Patients with public insurance were more likely to encounter delays in achieving recovery milestones. Public insurance status, serving as a proxy for a disadvantage in SDOH, is predictive of extended LOS and postoperative recovery delays following microsurgical breast reconstruction. This underscores the need for future quality improvement efforts to address and mitigate these disparities.

A Decade Long Analysis of Healthcare Disparities and Uterine Artery Embolization: An Exploration of Social Determinants of Health

To determine the extent that social determinants of health have on uterine artery embolization (UAE) utilization for treatment of symptomatic uterine fibroids. In this IRB-exempt study, data from the 2011-2020 National Inpatient Sample was used to identify patients with ICD-9 and -10 codes of uterine fibroids who underwent UAE. Data collected included: patient's demographics (race/ethnicity, income, insurance status) and procedure location (geographic region, hospital setting). Results are presented in percentage (UAE procedures per variable) and analyzed using Chi-square test. UAE utilization by race/ethnicity demonstrated the following distribution: Non-Hispanic Blacks (45.6%), Non-Hispanic Whites (28.1%), Hispanics (14.2%) and Asians (5.7%). The lowest quartile for income experienced no change in utilization (27.8%), while the highest quartile gradually decreased across the decade (2011:26.7%, 2020:19.0%, p=0.01). The Northeast region of the US (49.0% in 2011) was superseded by the South (34.8% in 2020) as the dominant geographic region for UAE. The main insurance statuses were private (55.5%) and Medicaid (26.2%), with Medicaid rates increasing throughout the decade (2011:18.2%, 2020: 28.6%, p < 0.001). Urban teaching hospitals accounted for the highest rates of total UAE (82.3%), compared to urban non-teaching (16.0%) and rural hospitals (1.2%). Over the past decade, UAE has been performed in a relatively equitable fashion on the basis income, with improved utilization within the Medicaid population and throughout the geographic regions of the US. When accounting for US population representation and unequal disease burden, Non-Hispanic Blacks demonstrated a greater-than-expected utilization of UAE, compared to lower-than-expected rates among Non-Hispanic Whites.