Racial Categories Research Articles

Performance of pulse oximeters as a function of race compared to skin pigmentation: a single center retrospective study.

Pulse oximetry (SpO2) is a critical monitor for assessing oxygenation status and guiding therapy in critically ill patients. Race has been identified as a potential source of SpO2 error, with consequent bias and inequities in healthcare. This study was designed to evaluate the incidence of occult hypoxemia and accuracy of pulse oximetry associated with the Massey-Martin scale and characterize the relationship between Massey scores and self-identified race. This retrospective single institute study utilized the Massey-Martin scale as a quantitative assessment of skin pigmentation. These values were recorded peri-operatively in patients enrolled in unrelated clinical trials. The electronic medical record was utilized to obtain demographics, arterial blood gas values, and time matched SpO2 values for each PaO2 ≤ 125 mmHg recorded throughout their hospitalizations. Differences between SaO2 and SpO2 were compared as a function of both Massey score and self-reported race. 4030 paired SaO2-SpO2 values were available from 579 patients. The average error (SaO2-SpO2) ± SD was 0.23 ± 2.6%. Statistically significant differences were observed within Massey scores and among races, with average errors that ranged from - 0.39 ± 2.3 to 0.53 ± 2.5 and - 0.55 ± 2.1 to 0.37 ± 2.7, respectively. Skin color varied widely within each self-identified race category. There was no clinically significant association between error rates and Massey-Martin scale grades and no clinically significant difference in accuracy observed between self-reported Black and White patients. In addition, self-reported race is not an appropriate surrogate for skin color.

Exploring the Relationship between Cerebral Palsy and Hip Dysplasia: Insights from the National Inpatient Sample.

Background and Objective: Cerebral palsy (CP) significantly impacts quality of life globally. Hip dysplasia (HD) is a common musculoskeletal issue in CP patients. This study investigates the prevalence, risk factors, and impact of HD on CP patients using a large national database. Materials and Methods: Data from the National Inpatient Sample (NIS) database (2016-2019) were used, identifying CP and HD diagnoses through ICD-10 codes. Baseline characteristics were tabulated. Univariate and multivariate logistic regression analyses examined predictors of HD development in CP patients, presenting data as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Among 3,951,040 pediatric patients, 28,880 had CP (27,466 without HD, and 1414 with HD), and 3,922,160 did not have CP. CP significantly increased the likelihood of developing HD in univariate (OR = 35.03, 95% CI [33.01, 37.17], p < 0.0001) and multivariate (OR = 26.61, 95% CI [24.94, 28.40], p < 0.0001) analyses. Among patients with CP, race was significantly associated with HD, with ORs below 1 for all racial categories compared to Whites. Females had nearly twice the odds of HD compared to males (OR = 1.96, 95% CI [1.86, 2.05], p < 0.0001). Age was significantly associated with HD, with each additional year increasing the odds (OR = 1.03, 95% CI [1.026, 1.034], p < 0.0001). Individuals in the high 51st-75th income quartile had a 17% increase in the odds of HD (OR = 1.17, 95% CI [1.09, 1.25], p < 0.0001) compared to the low 1st-25th income quartile. Conclusions: This study reinforces the strong association between CP and HD, highlighting the need for further research and prospective studies to validate these findings.

Association of Race and Ethnicity with Prescriptions for Continuous Glucose Monitoring Systems Among a National Sample of Veterans with Diabetes on Insulin Therapy.

Introduction and Objective: Continuous glucose monitoring (CGM) can improve glycemic control in people with diabetes on insulin therapy. We assessed rates of prescriptions for CGM in a national sample of Veterans across subgroups defined by race and ethnicity. Methods: This cross-sectional analysis of data from the U.S. Veterans Health Administration included adults with type 1 or type 2 diabetes on insulin therapy. Main exposures included self-reported race and ethnicity, and primary outcome was the percentage of patients with at least one CGM prescription between January 1, 2020, and December 31, 2021. Association of race and ethnicity categories with CGM prescription was examined using multilevel, multivariable mixed-effects models. Results: Among 368,794 patients on insulin (mean age, 68.5 years; 96% male; 96.8% type 2 diabetes; 0.8% American Indian or Alaska Native, 0.7% Asian, 18.9% Black or African American, 0.9% Native Hawaiian or other Pacific Islander, 70.2% White, 2.8% multiracial, 5.7% with unknown race, and 7.0% Hispanic or Latino ethnicity), 11.2% were prescribed CGM. CGM was prescribed for 10.4% American Indian or Alaska Native, 9.7% Asian, 9.2% Black or African American, 9.3% Native Hawaiian or other Pacific Islander, 11.8% White, 11.8% multiracial, and 10.1% patients with unknown race. CGM was prescribed for 8.3% Hispanic or Latino, 11.4% non-Hispanic, and 11.5% of patients with unknown ethnicity. After accounting for patient-, clinical-, and system-level factors, Black or African American patients had significantly lower odds of CGM prescription compared with White patients (adjusted odds ratio [aOR] 0.62, 95% confidence interval [CI] 0.59-0.64), whereas Hispanic or Latino patients had significantly lower odds compared with non-Hispanic patients (aOR 0.79, 95% CI 0.74-0.84). Findings were consistent across subgroups with clinical indications for CGM use. Conclusions: Among Veterans with diabetes on insulin therapy, there were significant disparities in prescribing of CGM technology by race and ethnicity, which require further study and intervention.

Cannabis Use and Associated Risk Behavior Factors among High School Students in Mississippi: Youth Risk Behavior Surveillance System 2021.

Cannabis is the most used illicit drug among youths in the United States. The objectives of this study were to identify the association between cannabis use and other risk behaviors, including suicidality, among high school students. This is a cross-sectional study using the 2021 Mississippi Youth Risk Behavior Surveillance System (YRBS). The 2021 YRBS data sets were combined for this study. The crude odds ratio (OR) and adjusted odds ratio (AOR) with a 95% confidence interval were generated using the survey packages in R to account for weights and the complex sampling design of the YRBS data. Univariate analysis identified seven risky behaviors that were significantly associated with current cannabis use, including carrying weapons on school campuses, suicidal attempts, electronic vapor use, current smoking, current drinking, sexual behaviors, and unsupervised children. In multivariable analysis, after adjusting for gender, race, students' grades, and other risky behaviors, statistically significant variables for cannabis use included current use of electronic vapor, current smoking, current drinking, and sexual behaviors. Cannabis use is evenly burdened between males and females and between all race categories among Mississippi high school students. The identified associations seem to indicate that electronic vapor, tobacco products, and alcohol use could be the forerunners for drug use and should be treated accordingly in drug use prevention programs.

Fractures by race and ethnicity in a diverse sample of postmenopausal women: a current evaluation among Hispanic and Asian origin groups.

Using 1998-2022 Women's Health Initiative (WHI) data, our study provides contemporary fracture data by race and ethnicity, specifically focusing on Hispanic and Asian women. Fractures of interest included any clinical, hip, and major osteoporotic fractures (MOFs). We utilized the updated race and ethnicity information collected in 2003, which included seven Asian and five Hispanic origin groups. We computed crude and age-standardized fracture incidence rates per 10 000 woman-years across race and ethnic categories and by Asian and Hispanic origin. We used Cox proportional hazards model, adjusting for age and WHI clinical trial arm, to evaluate the risk of fracture (1) by race compared to White women, (2) Asian origin compared to White women, (3) Hispanic compared to non-Hispanic women, and (4) Asian and Hispanic origins compared the most prevalent origin group. Over a median (interquartile range) follow-up of 19.4 (9.2-24.2) years, 44.2% of the 160 824 women experienced any clinical fracture, including 36 278 MOFs and 8962 hip fractures. Compared to White women, Black, Pacific Islander, Asian, and multiracial women had significantly lower risk of any clinical and MOFs, while only Black and Asian women had significantly lower hip fracture risk. Within Asian women, Filipina women had 24% lower risk of any clinical fracture compared to Japanese women. Hispanic women had significantly lower risk of any clinical, hip, and MOF fractures compared to non-Hispanic women, with no differences in fracture risk observed within Hispanic origin groups. In this diverse sample of postmenopausal women, we confirmed racial and ethnic differences in fracture rates and risk, with novel findings among within Asian and Hispanic subgroups. These data can aid in future longitudinal studies evaluate contributors to racial and ethnic differences in fractures.

Racism without ‘race’: colorblindness, blackness and everyday racism in contemporary Germany

ABSTRACT Germany does not officially use or recognize racial categories. Despite this absence, everyday racism is a common experience for Black Germans and others viewed as non-European. Drawing on interviews with Black Germans, this article reveals the multiple ways in which Black Germans are racialized in everyday life. The most common form is ‘foreignization’ or the presumption that Black Germans are immigrants. This particular form of racialization can be seen as a consequence of the refusal to acknowledge race as a concept, and substituting the language of citizenship and migration for it. Interviews also illustrate how Black Germans’ self-identifications are both shaped by and challenge this absence of race as a term. The absence of racial categories maintains the notion of Germanness as white, and Blackness as non-German. Examining race in the German context offers unique insights into the comparative study of race in the contemporary colorblind era.

Chi-Squared Automatic Interaction Detection Decision Tree Analysis of Social Determinants for Low Birth Weight in Virginia.

This study provides additional context to the literature regarding the social inequities that impact birth outcomes in Virginia using a decision tree analysis. Chi-squared automatic interaction detection data analysis (CHAID) was performed using data from the Virginia birth registry for the years 2015-2019. Birth weight was the outcome variable, while sociodemographic factors and maternity care deserts were the explanatory variables. The prevalence of low birth weight in Virginia was of 8.1%. The CHAID decision tree model demonstrated multilevel interaction among risk factors with three levels, with a total of 34 nodes. All the variables reached significance in the model, with race/ethnicity being the first major predictor variable, each category of race and ethnicity having different significant predictors, followed by prenatal care and maternal education in the next levels. These findings signify modifiable risk factors for low birth weight, in prioritizing efforts such as programs and policies. CHAID decision tree analysis provides an effective approach to detect target populations for further intervention as pathways derived from this decision tree shed light on the different predictors of high-risk population in each of the race/ethnicity demographic categories in Virginia.

Association of genetic ancestry with molecular tumor profiles in colorectal cancer

BackgroundThere are known disparities in incidence and outcomes of colorectal cancer (CRC) by race and ethnicity. Some of these disparities may be mediated by molecular changes in tumors that occur at different rates across populations. Genetic ancestry is a measure complementary to race and ethnicity that can overcome missing data issues and better capture genetic similarity in admixed populations. We aimed to identify somatic mutations and tumor gene expression differences associated with both genetic ancestry and imputed race and ethnicity.MethodsSequencing was performed with the Tempus xT NGS 648-gene panel and whole exome capture RNA-Seq for 8454 primarily late-stage CRC patients. Genetic ancestry proportions for five continental groups—Africa (AFR), American indigenous (AMR), East Asia (EAS), Europe (EUR), and South Asia (SAS)—were estimated using ancestry informative markers. To address data gaps, race and ethnicity categories were imputed, resulting in assignments for 952 Hispanic/Latino, 420 non-Hispanic (NH) Asian, 1061 NH Black, and 5763 NH White individuals. We assessed association of genetic ancestry proportions and imputed race and ethnicity categories with somatic mutations in relevant CRC genes and in 2608 expression profiles, as well as 1957 consensus molecular subtypes (CMS).ResultsIncreased AFR ancestry was associated with higher odds of somatic mutations in APC, KRAS, and PIK3CA and lower odds of BRAF mutations. Additionally, increased EAS ancestry was associated with lower odds of mutations in KRAS, EUR with higher odds in BRAF, and the Hispanic/Latino category with lower odds in BRAF. Greater AFR ancestry and the NH Black category were associated with higher rates of CMS3, while a higher proportion of Hispanic/Latino patients exhibited indeterminate CMS classifications.ConclusionsMolecular differences in CRC tumor mutation frequencies and gene expression that may underlie observed differences by race and ethnicity were identified. The association of AFR ancestry with increased KRAS mutations aligns with higher CMS3 subtype rates in NH Black patients. The increase of indeterminate CMS in Hispanic/Latino patients suggests that subtype classification methods could benefit from enhanced patient diversity.

Making Sense of Racial Membership

AbstractWhich individuals belong to a racial group, and what determines membership? I argue that questions about membership are importantly different from questions regarding the ontology of racial categories and invite a distinctive line of inquiry. But there's a formidable challenge to providing determinate and consistent answers to membership questions: Many phenomena documented in sociology and psychology generate reasonable and systematic disagreement about membership that cannot be adjudicated by an influential variety of social constructionism. While the puzzle of racial identity remains, we emerge with a new appreciation for how racial membership is a distinctive part of it.

Sickly, Idle and Risky Minorities: Race and Diabetes under Singapore’s Emergent “Insurantial Imaginary”

This article highlights the role of the “insurantial imaginary”, defined as a social context in which profitable, useful and necessary uses can be found for insurance technology, as a condition that shaped the articulation of the sickly, idle and risky racial minorities within Singapore’s public health discourse on diabetes. Focusing on parliamentary speeches relating to diabetes between 1965 to 2020 as well as healthcare financing policy documents, I argue that the narrative of sickly, idle and risky minorities bodies tied to broader notions of racialized responsibility and accountability emerged sharply under a universal national health insurance system. Where parliamentary discussions on diabetes as a public health issue before the institution of universal health insurance circa 2014 utilized racial categories in the classificatory or administrative sense, these very categories became endowed with new meanings and moral imperatives, where Malays and Indians were urged to lead healthier lifestyles to reduce the national insurantial burden. This study builds on the literature on race in medicine by underlining the role of healthcare financing as a technology of racial biopolitics.

From othering to belonging: a framework for DEI history-telling and strategising

The medical profession in the USA is—and has long been—a segregated workforce. Currently, just 5.0% of all US physicians are black. Understanding the origins and mechanisms of this disparity is...

National trends in pneumonia-related mortality in the United States, 1999-2019

Introduction Pneumonia is one of the most common causes of hospital admissions in the United States and remains a major cause of death. However, less is known regarding the mortality burden from pneumonia in the United States and how this burden has changed over time. Methods Death rates from causes related to pneumonia were determined using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) data from 1999-2019. Pneumonia deaths were calculated for the overall population as well as for sociodemographic subgroups. We also analysed changes in death rates over time. Results Overall, 2.1% of total US deaths during the period between 1999 and 2019 were due to pneumonia (2.6% in 1999 and 1.5% in 2019). Mortality declined over time for both men and women, and across most age cohorts, as well as all racial, urbanisation, and regional categories. Rates of pneumonia deaths were higher among males as compared to females (age-adjusted mortality rate ratio (AAMRR) = 1.35; 95% CI: 1.34-1.35). Compared to White Americans, Black Americans had the highest pneumonia-related mortality rates of any racial group (AAMRR = 1.11; 95% CI: 1.10-1.11). Conclusions Rates of pneumonia-related death have decreased in the United States in recent decades. However, significant racial and gender disparities remain, indicating the need for more equitable care.

Estimation of sex assigned at birth using dental crown and cervical measurements in a modern global sample.

Despite developing prior to the appearance of secondary sexual characteristics of the skeleton, the permanent dentition exhibits sexual dimorphism. Therefore, teeth can serve as a means to estimate sex assigned at birth even in young individuals. This project takes a large global sample of maximum dimensions of the crown as well as measurements of the crown at the cervix to explore sexual dimorphism. Dimorphism is noted in teeth throughout the dental arcade, particularly in the canines. We provide sectioning points as well as the probability of correct classification (ranging from 50.9% to 81.3%) for each measurement to aid the practitioner in sex estimation from the dentition. This research provides a method to estimate sex without arbitrary population specifications. We argue for a global approach that incorporates more population variation to remove the need to estimate "ancestry," (which in actuality is translated to a social race category) and therefore does not force sexual dimorphism-related variation into these mutable and ambiguous categories. Further, this paper demonstrates the utility of the dentition as an additional indicator to aid with the estimation of sex assigned at birth in forensic anthropology. The goal of this research is to better understand the expression of sexual dimorphism across the skeleton in a global context.

Racial salience modulated the face race lightness illusion: A comparative study of Caucasians and Asians.

Previous research has demonstrated the existence of the face race lightness (FRL) illusion. It indicates that Black faces tend to appear darker than White faces, even when their luminance values are objectively adjusted to be the same. However, the debate over the exclusive influence of face-race categories on the FRL illusion continues, with the impact of racial groups on the illusion remaining relatively unexplored. To address these gaps, we conducted studies to investigate whether the FRL illusion varies in terms of racial salience and racial groups. We manipulated the racial salience by altering the orientation of the faces. A total of 64 Caucasians (Study 1) and 63 Asians (Study 2) were recruited. Participants were shown pairs of faces in rapid succession and were asked to report which face appeared lighter or darker. In each trial, the two faces belonged to the same race category: Black, Black-White ambiguous, or White. The luminance of the first face remained consistent across trials while the luminance of the second face varied and was adjusted across eight levels (- 20, - 12, - 8, - 4, + 4, + 8, + 12, + 20). Our findings reveal that the FRL illusion is largely dependent on the salience of face-race information. When faces were presented upright, the FRL illusion was prominent; however, it disappeared when faces were inverted. Remarkably, the FRL illusion was observed not only in Caucasians but also in Asians. Therefore, our results suggest that the FRL illusion primarily stems from race salience rather than participants' racial groups.

Building the NHPI Data Policy Platform to Identify the Most Pressing SDOH Policy Domains for the NHPI Community

Abstract: Access to accurate Native Hawaiian and Pacific Islander (NHPI) social drivers of health (SDOH) data is crucial for understanding health needs and shaping effective public health strategies. However, this data often gets obscured within broader racial and ethnic categories making NHPI issues invisible. Moreover, NHPI communities face barriers when published data formats are inaccessible to community-based organization staff. To tackle these challenges, we initiated the Assessing Social Determinants of Health Data Through Local Data Intermediaries Initiative (AHEAD), supported by the federal Office of Minority Health. We developed two community-centered resources: 1. The NH PI Data Policy Platform, shaped by 138 NHPI community leaders from 13 states and Washington, D.C., representing nine NHPI subgroups. This platform highlights NHPI priority issues and provides equitable data policy recommendations for advocates and policymakers. 2. An NHP I SDOH Dashboard for California Counties, tailored to offer accessible data for community-based organization staff, ensuring better-informed interventions and support.

Vaccine patterns among older adults with Guillain-Barré syndrome and matched comparators, 2006-2019.

Some vaccines have a small risk of triggering Guillain-Barré syndrome (GBS), an autoimmune disorder where nerve damage leads to paralysis. There is a CDC precaution for patients whose GBS was associated with an influenza or tetanus toxoid-containing vaccine (GBS occurring within 42 days following vaccination). We described vaccine patterns before and after a GBS diagnosis with a matched cohort design in a 20% random sample of fee-for-service Medicare enrollees. We defined the index date as an ICD-9-CM or ICD-10-CM GBS diagnosis code in the primary position of an inpatient claim. We matched each GBS patient to five non-GBS comparators on sex, exact age, racial and ethnic category, state of residence and the month of preventive health visits during baseline; used weighting to balance covariates; and measured frequency of vaccines received per 100 people during year before and after the index date using the weighted mean cumulative count (wMCC). We identified 1567 patients with a GBS diagnosis with at least 1 year of prior continuous enrollment in Medicare A and B that matched to five comparators each. The wMCCs in the 1 year before the index date were similar for both groups, with a wMCC of 74 vaccines/100 people in the GBS group (95% CI 71, 77). Within 1 year after the index date, patients with GBS had received 26 vaccines/100 people (95% CI 23, 28), which was 41 fewer vaccines than matched non-GBS comparators (95% CI -44, -38). Among GBS patients, 11% were diagnosed with GBS within 42 days after a vaccine. GBS diagnosis has a strong impact on reducing subsequent vaccination even though there is no warning or precaution about future vaccines for most patients diagnosed with GBS. These data suggest discordance between clinical practice and current vaccine recommendations.

Epidemiologic Analysis of a Postelimination Measles Outbreak in Central Ohio, 2022-2023

Postelimination outbreaks threaten nearly a quarter century of measles elimination in the US. Understanding these dynamics is essential for maintaining the nation's measles elimination status. To examine the demographic characteristics and transmission dynamics of the 2022 to 2023 central Ohio measles outbreak. This cross-sectional study used electronic medical records and publicly available measles reports within an extensive central Ohio primary care network involving inpatient and outpatient settings. Participants included 90 children in Ohio with confirmed measles cases in 2022. The exposure of interest was confirmed measles cases in Ohio in 2022. This included 5 internationally imported cases and 85 locally acquired cases. The primary outcome involved documenting and analyzing confirmed measles cases in Ohio in 2022, focusing on demographic characteristics, immunization status, and transmission links in outbreak-related cases. This study analyzed 90 measles cases (47 [52.2%] male participants) in Ohio during 2022. Most participants self-identified as African or American Black (72 [80.0%]), with additional race categories including Asian, Hispanic, multirace (6 [6.7%]), White, and unknown (6 [6.7%]). Most participants were of Somali descent (64 [71.1%]), with additional ethnicity categories including American (16 [17.8%]), Guatemalan, Nepali, and unknown (6 [6.7%]). Participants were predominantly younger than 6 years (86 [95.5%]), unimmunized (89 [98.9%]), and resided in Franklin County, Ohio (83 [92.2%]). Prior to November 20, 2022, all cases occurred among unimmunized children of Somali descent in the Columbus area. Nosocomial superspreading events expanded the outbreak beyond the initially affected community. This cross-sectional study of measles cases in Ohio during 2022 found that the outbreak primarily affected unimmunized children of Somali descent, highlighting the necessity for culturally tailored public health strategies to maintain measles elimination in the US. These findings underscore the importance of implementing targeted interventions and enhancing community engagement to increase vaccination rates.

Understanding pediatric inpatient conductive hearing loss: An analysis of patient demographics

ObjectiveHearing loss is a common sensory impairment in children that affects quality of life and development. Early intervention, such as hearing aids and communication therapies, can help children overcome these challenges and lessen the impact on their development. The objective of this study was to identify specific patient demographic factors correlated with the prevalence of pediatric conductive hearing loss. Study designThe study utilized the Kids' Inpatient Database (KID) by the Agency for Healthcare Research and Quality which collects inpatient information from hospitals for patients under 21 years old. We included all patients discharged in 2016 diagnosed with conductive hearing loss, and excluded neonatal patients discharged within 28 days of birth. MethodsStatistical analyses were performed using R Studio and IBM SPSS Statistics. Weighted odds ratios were calculated for conductive hearing loss in relation to race and income, and a multivariate regression analysis examined associations between demographic variables and race categories in conductive hearing loss. ResultsThe prevalence of conductive hearing loss (CHL) in pediatric patients in 2016 was 51.62 cases per 100,000 patients. Non-Hispanic White patients had the highest prevalence, while Black patients had the highest likelihood of CHL compared to the overall population. Lower income levels were associated with a decreased probability of CHL diagnosis. After adjusting for age, sex, hospital region, insurance, and income on multivariate analysis, White and Black patients were less likely to be diagnosed with CHL. Furthermore, patients in specific income quartiles also had lower CHL likelihood compared to the general population. ConclusionWhile Black patients had a higher likelihood of being diagnosed with CHL than the general population, socioeconomic factors such as income greatly influenced the likelihood of CHL diagnosis. Other significant factors included income, region of the country, sex, and age. Further research is needed to better understand and address healthcare disparities related to pediatric hearing loss.

"White" as a Racial Category, Perceptions of Mistreatment, and Health.

"White" as a Racial Category, Perceptions of Mistreatment, and Health.

Examining the Academic Achievement of Latinx Students from an Early Lifespan and Intersectional Perspective

ABSTRACT The present study examined Latinx school readiness and 3rd grade student achievement, considering differences based on social categories of gender, race, ethnicity, and home language. The sample included 683 racially diverse children (Mage = 4.94; SD = .57) of Dominican- or Mexican-origin from Spanish-English or Spanish-only proficient homes. Baseline data included a test of school readiness and mother and teacher ratings of behavior. Follow-up data included the 3rd grade New York State test. Results show that 74% of Latinx children were not proficient in 3rd grade reading, with boys and children from Spanish-only homes less likely to be at grade level. School readiness predicted achievement for all groups. On the whole, Latinx students, and especially boys and non-English speakers, appear to be marginalized in U.S. public education systems.