American Race Research Articles

Localized Racism, Legalized Theft, and the Long Dispossession of U.S. Cities

Andrew Kahrl's The Black Tax is a sweeping and insightful history of the local property tax in the United States from Reconstruction onward that speaks eloquently to urban history, tax history, and histories of capitalism and race in the United States. Kahrl exposes the relentless process of dispossession and exploitation, captive taxpayers and fiscal apartheid within the local property tax that has overtaxed Black Americans by over $275 billion, cost $326 billion in land loss, and created a generational wealth difference compounded into trillions. But Kahrl is not focused only on individual loss or even community dispossession, but on entrenched systems of legalized theft built into the local property tax that have reinforced themselves over time through the most localized bureaucratic subjectivity and bias, such that poor cities are now left with few fiscally sustaining options other than preying on their poorest citizens.

Achieving Equity in Hypertension: A Review of Current Efforts by the American Heart Association.

The purpose of this article is to summarize disparities in blood pressure (BP) by race in the United States, discuss evidence-based strategies to increase equity in BP, review recent American Heart Association BP equity initiatives, and highlight missed opportunities for achieving equity in hypertension. Over 122 million American adults have hypertension, with the highest prevalence among Black Americans. Racial disparities in hypertension and BP control in the United States are estimated to be the single largest contributor to the excess risk for cardiovascular disease among Black versus White adults. Worsening disparities in cardiovascular disease and life expectancy during the COVID-19 pandemic warrant an evaluation of the strategies and opportunities to increase equity in BP in the United States. Racial disparities in hypertension are largely driven by systemic inequities that limit access to quality education, economic opportunities, neighborhoods, and health care. To address these root causes, recent studies have evaluated evidence-based strategies, including community health workers, digital health interventions, team-based care, and mobile health care to enhance access to health education, screenings, and BP care in Black communities. In 2021, the American Heart Association made a $100 million pledge and 10 commitments to support health equity. This commitment included implementing multifaceted interventions with a focus on hypertension as a seminal risk factor contributing to disparities in cardiovascular disease mortality and morbidity. The American Heart Association is one organizational example of advocacy for equity in BP. Achieving equity nationwide will require sustained collaboration among individual stakeholders and public, private, and community organizations to address barriers across multiple socioecological levels.

Medical gendered racism and Black women's experiences of genito-pelvic pain/penetration disorder in the USA - A conceptual exploration.

Medical gendered racism in the USA has been and continues to be a significant issue for Black women across various healthcare domains, including sexual and pelvic healthcare. The experiences of Black women with Genito-Pelvic Pain/Penetration Disorder, characterised by pain with sexual intercourse, are particularly understudied in relation to medical gendered racism. This paper advances existing research on Genito-Pelvic Pain/Penetration Disorder by employing Black feminist thought and intersectionality as theoretical frameworks. We seek to conceptualise how medical gendered racism impacts Black women's experiences with genito-pelvic pain and the quality of their healthcare. We offer a nuanced, culturally sensitive approach to doing so and to clinical practice, and provide actionable recommendations for healthcare professionals. This work aims to equip researchers and healthcare practitioners with the knowledge and tools to acknowledge, understand, and support effective treatment of genito-pelvic pain experienced by Black women in the USA.

Incidence Trends in Upper Gastrointestinal Cancer in Young Adults: A Nationwide Time-Trend Analysis Using 2001-2019 US Cancer Statistics Databases.

Upper gastrointestinal (UGI) cancers, comprising malignancies of the esophagus, stomach, duodenum, pancreas, liver, biliary tract, and gallbladder, are the second leading cause of cancer-related mortality in the United States and are associated with significant comorbidities. Recent studies show a disproportionate rise in pancreatic and stomach cancer among young adults. This study aims to use a nationwide, population-based cohort to (i) evaluate the trend of all UGI cancer as an aggregate and (ii) examine the role of demographics, histology, and tumor stage in UGI cancer incidence among young adults. Individuals diagnosed with UGI cancer in the United States from 2001 to 2019 were identified and obtained from the Surveillance, Epidemiology, and End Results-National Program of Cancer Registries database. The primary outcomes were incidence rates of UGI cancer (calculated per 100,000, age-adjusted to the year 2000 US population), stratified by sex and age (< 55 years for young adults and ≥ 55 years for older adults). Trends, annual percentage change, and average annual percentage change were calculated using the parametric method. Sensitivity analysis was performed according to primary site and histology; further analysis examining race and cancer stage was performed in the young adult subgroup. A total of 2,333,161 patients with UGI cancer were identified. Most cases were male, and 14.3% were < 55 years of age. Incidence of UGI cancer increased most in women younger than 55 years, driven primarily by pancreatic and stomach cancers, as well as neuroendocrine tumor and gastrointestinal stromal tumor histology. African American race and localized tumors and malignancy with distant spread are also contributing to the disparate increase among young women. UGI mortality rates have not changed significantly in young adults. The overall incidence rate of upper gastrointestinal cancer is increasing significantly in young women compared with men. Increased endoscopic procedures and disparate exposure to risk factors are likely contributing to these trends.

Facing the Truth and Moving Forward: The Complicity of Pediatricians with Racism in the United States

Facing the Truth and Moving Forward: The Complicity of Pediatricians with Racism in the United States

Fatal and Nonfatal Firearm Injury Rates by Race and Ethnicity in the United States, 2019 to 2020.

Racial disparities in firearm injury death in the United States are well established. Less is known about the magnitude of nonfatal and total firearm injury. To combine health care data with death certificate data to estimate total firearm injuries in various racial and ethnic groups. Retrospective, cross-sectional study. Fatal injury data were collected from the Centers for Disease Control and Prevention. Data on nonfatal injuries were collected from the Nationwide Emergency Department Sample (NEDS), a 20% stratified sample of U.S. emergency department visits, weighted to provide national estimates for the United States, 2019 to 2020. All firearm injuries and deaths in the United States. Race and ethnicity were classified into 5 mutually exclusive categories: Asian or Pacific Islander, Black, Hispanic, Native American, and White. International Classification of Diseases, 10th Revision codes were used to classify firearm injury intent. Incidence of fatal and nonfatal injury in the U.S. population and case-fatality ratios (CFRs). There were 252 376 total firearm injuries, including 84 908 deaths from firearm injures. Of all firearm injuries, 37.8% were unintentional, 37.3% were assault related, 21.0% were self-harm, and 1.3% were law enforcement associated. Self-harm had the highest CFRs (90.9% overall). Unintentional injuries accounted for just 1021 (1.2%) deaths but 94 433 (56.4%) of nonfatal injuries. Rates of self-harm were highest among White persons (11.0 per 100 000 population in 2020) followed by Native Americans (8.6 per 100 000). Rates of assault were highest among Black persons (70.1 per 100 000), as were unintentional injuries (56.1 per 100 000). Findings are limited by the accuracy of discharge coding in NEDS, particularly regarding injury intent and patient race and ethnicity. From 2019 to 2020, the total burden of firearm injuries amounts to an average of 1 injury every 4 minutes and 1 death every 12 minutes in the United States. Racial disparities in firearm injury death are mirrored in nonfatal injury. None.

1378P Improvements in stage IV non-small cell lung cancer survival differ by race in the US

1378P Improvements in stage IV non-small cell lung cancer survival differ by race in the US

A Comparative Analysis of Dramatic Structure in Lorraine Hansberry’s A Raisin in the Sun (1959) and August Wilson’s Fences (1986)

This paper conducts a comparative analysis of the dramatic structures in Lorraine Hansberry’s A Raisin in the Sun and August Wilson’s Fences, utilizing Freytag’s Pyramid as a framework. Despite differences in scene and act composition, both plays share a similar narrative structure marked by multiple climactic points rather than a single one. Each play presents the lives of African American families in mid-20th century America, grappling with themes of racial oppression, economic hardship, and personal aspirations. Hansberry’s work primarily addresses the relationship between African Americans and White society, while Wilson’s focuses on intergenerational conflicts within a Black family. Both playwrights weave moments of heightened tension throughout the narratives, surprising audiences with new inciting incidents just as the action seems to be falling. This study reveals that although Fences was written nearly 30 years after A Raisin in the Sun, the two plays mirror one another in their exploration of socio-economic struggles and racial dynamics. Ultimately, the paper illustrates how both works encapsulate a continuous struggle for dignity and self-actualization within the constraints of a racially discriminatory society.

Long COVID Illness: Disparities in Understanding and Receipt of Care in Emergency Department Populations

BackgroundMost Long COVID studies rely on traditional surveillance methods that miss underserved populations who use emergency departments (EDs) as their primary health care source. ObjectivesIn medically-underserved ED populations, we sought to determine 1) whether there are gaps in awareness and self-declared understanding about Long COVID illness, and 2) the prevalence, impact, and receipt of care for Long COVID symptoms. Design, Setting and ParticipantsCross-sectional, convenience sample survey study of adult patients at 11 geographically representative US EDs from 12/2022-10/2023. MeasurementsAwareness and self-declared understanding about Long COVID illness; prevalence, impact, and receipt of care for Long COVID symptoms. ResultsOf 1618 eligible patients,1455 (89.9%) agreed to participate: 33.4% African American, 30.9% Latino/a, and 17.1% lacked primary care; 33.2% had persistent COVID symptoms lasting > 1-month, 20.3% had symptoms > 3-months; 49.8% with Long COVID symptoms missed work/school because of symptoms; 30.3% of all participants and 33.5% of participants who had Long COVID symptoms had prior awareness and self-declared understanding of Long COVID. Characteristics associated with poor understanding of Long COVID were: African American race (adjusted odds ratio [aOR] 3.68, 95% confidence interval [CI] 2.66-5.09) and Latino/a ethnicity (aOR 3.16, 95% CI 2.15-4.64). Participants lacking primary care were less likely to have received Long COVID care (24.6% vs 51.2%; difference 26.6%; 95% CI 13.7-36.9%). Conclusions/RelevanceDespite high prevalence and impact of Long COVID symptoms, most of this ED population had limited awareness and self-declared understanding of Long COVID and many had not received care. EDs should consider development of protocols for diagnosis, education, and treatment of Long COVID illness.

Accuracy and Interpretation of Transcutaneous Carbon Dioxide Monitoring in Critically Ill Children.

Transcutaneous carbon dioxide (Tc co2 ) monitoring can noninvasively assess ventilation by estimating carbon dioxide ( CO2 ) levels in the blood. We aimed to evaluate the accuracy of Tc co2 monitoring in critically ill children by comparing it to the partial pressure of arterial carbon dioxide (Pa co2 ). In addition, we sought to determine the variation between Tc co2 and Pa co2 acceptable to clinicians to modify patient care and to determine which patient-level factors may affect the accuracy of Tc co2 measurements. Retrospective observational cohort study. Single, quaternary care PICU from July 1, 2012, to August 1, 2020. Included participants were admitted to the PICU and received noninvasive ventilation support (i.e., continuous or bilevel positive airway pressure), conventional mechanical ventilation, or high-frequency oscillatory or percussive ventilation with Tc co2 measurements obtained within 15 minutes of Pa co2 measurement. None. Three thousand four hundred seven paired arterial blood gas and Tc co2 measurements were obtained from 264 patients. Bland-Altman analysis revealed a bias of -4.4 mm Hg (95% CI, -27 to 18.3 mm Hg) for Tc co2 levels against Pa co2 levels on the first measurement pair for each patient, which fell within the acceptable range of ±5 mm Hg stated by surveyed clinicians, albeit with wide limits of agreement. The sensitivity and specificity of Tc co2 to diagnose hypercarbia were 93% and 71%, respectively. Vasoactive-Infusion Score (VIS), age, and self-identified Black/African American race confounded the relationship between Tc co2 with Pa co2 but percent fluid overload, weight-for-age, probe location, and severity of illness were not significantly associated with Tc co2 accuracy. Tc co2 monitoring may be a useful adjunct to monitor ventilation in children with respiratory failure, but providers must be aware of the limitations to its accuracy.

Obtaining the Most Accurate, Explainable Model for Predicting Chronic Obstructive Pulmonary Disease: Triangulation of Multiple Linear Regression and Machine Learning Methods.

Lung disease is a severe problem in the United States. Despite the decreasing rates of cigarette smoking, chronic obstructive pulmonary disease (COPD) continues to be a health burden in the United States. In this paper, we focus on COPD in the United States from 2016 to 2019. We gathered a diverse set of non-personally identifiable information from public data sources to better understand and predict COPD rates at the core-based statistical area (CBSA) level in the United States. Our objective was to compare linear models with machine learning models to obtain the most accurate and interpretable model of COPD. We integrated non-personally identifiable information from multiple Centers for Disease Control and Prevention sources and used them to analyze COPD with different types of methods. We included cigarette smoking, a well-known contributing factor, and race/ethnicity because health disparities among different races and ethnicities in the United States are also well known. The models also included the air quality index, education, employment, and economic variables. We fitted models with both multiple linear regression and machine learning methods. The most accurate multiple linear regression model has variance explained of 81.1%, mean absolute error of 0.591, and symmetric mean absolute percentage error of 9.666. The most accurate machine learning model has variance explained of 85.7%, mean absolute error of 0.456, and symmetric mean absolute percentage error of 6.956. Overall, cigarette smoking and household income are the strongest predictor variables. Moderately strong predictors include education level and unemployment level, as well as American Indian or Alaska Native, Black, and Hispanic population percentages, all measured at the CBSA level. This research highlights the importance of using diverse data sources as well as multiple methods to understand and predict COPD. The most accurate model was a gradient boosted tree, which captured nonlinearities in a model whose accuracy is superior to the best multiple linear regression. Our interpretable models suggest ways that individual predictor variables can be used in tailored interventions aimed at decreasing COPD rates in specific demographic and ethnographic communities. Gaps in understanding the health impacts of poor air quality, particularly in relation to climate change, suggest a need for further research to design interventions and improve public health.

Characterizing apparent treatment resistant hypertension in the United States: insights from the All of Us Research Program.

Hypertension (HTN) remains a significant public health concern and the primary modifiable risk factor for cardiovascular disease, which is the leading cause of death in the United States. We applied our validated HTN computable phenotypes within the All of Us Research Program to uncover prevalence and characteristics of HTN and apparent treatment-resistant hypertension (aTRH) in United States. Within the All of Us Researcher Workbench, we built a retrospective cohort (January 1, 2008-July 1, 2023), identifying all adults with available age data, at least one blood pressure (BP) measurement, prescribed at least one antihypertensive medication, and with at least one SNOMED "Essential hypertension" diagnosis code. We identified 99 461 participants with HTN who met the eligibility criteria. Following the application of our computable phenotypes, an overall population of 81 462 were further categorized to aTRH (14.4%), stable-controlled HTN (SCH) (39.5%), and Other HTN (46.1%). Compared to participants with SCH, participants with aTRH were older, more likely to be of Black or African American race, had higher levels of social deprivation, and a heightened prevalence of comorbidities such as hyperlipidemia and diabetes. Heart failure, chronic kidney disease, and diabetes were the comorbidities most strongly associated with aTRH. β-blockers were the most prescribed antihypertensive medication. At index date, the overall BP control rate was 62%. All of Us provides a unique opportunity to characterize HTN in the United States. Consistent findings from this study with our prior research highlight the interoperability of our computable phenotypes.

Huck’s Voice versus Herd Mentality: The Good, the Bad, and the Evil

In Mark Twain's 1884 chef-d‘œuvre, The Adventures of Huckleberry Finn (HF), the voice of innocence—personified by Huck Finn—evolves as a graphic reflection of his unique social and ethical standing, portraying him as a nonconforming, Adam-like wanderer seeking refuge in nature and searching for a distinct identity. Employing literary theory, this article goes beyond exposing the moral bankruptcy and hypocrisy in an allegedly ‘civilized’ white society that purports to uphold high moral standards. Drawing on Nietzsche's doctrine of good vs. bad and good vs. evil, along with the psychological phenomenon of herd mentality, the article demonstrates how Huck's voice challenges and destabilizes orthodox linguistic conventions, societal norms, ethical constructs, and long-standing beliefs in the antebellum American South during the nineteenth century. Key findings reveal that such a unique voice can be seen as a profound critique of the antebellum South’s values, introducing a newfangled perspective on America's development of a distinctive identity and its quest to establish its own voice and literature after severing ties with Britain.

Outpatient vs. inpatient designation in total hip arthroplasty: can we predict who will require hospitalization?

Following removal of total hip arthroplasty (THA) from the inpatient only (IPO) list by the Center for Medicare Services (CMS), arthroplasty surgeons face increased pressure to perform procedures on an outpatient (OP) basis. The purposes of the present study were to compare patients booked for THA as OP who required conversion to IP status postoperatively, to patients who were booked as, and remained OP, and to identify factors predictive of conversion from OP to IP status. We retrospectively reviewed all patients who underwent a primary THA at our institution between January 1, 2020 and April 26, 2022. All patients included were originally scheduled for OP surgery and were separated based on conversion to IP status postoperatively. Multiple regression analyses were used to determine the significance of all perioperative variables. Modeling via binary logistic regressions were used to determine factors predictive of status conversion. Of 1,937 patients, 372 (19.2%) designated as OP preoperatively required conversion to IP status postoperatively. These patients had significantly higher facility discharge rates (P < 0.001) and 90-day readmission rates (P = 0.024). Patients aged 65 and older (P < 0.001), females (P < 0.001), patients with Black/African American race (P = 0.027), with a recovery room arrival time after 12pm (P < 0.001), with a BMI > 30kg/m2 (P = 0.001), and with a Charlson Comorbidity Index (CCI) ≥ 4 (P = 0.013) were Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation more likely to require conversion to IP designation. Marital status and time of procedure were also significant factors, as patients who were married (P < 0.001) and who were the first case of the day (P < 0.001) were less likely to be converted to IP. Several factors were identified which could help determine appropriate hospital designation status at the time of surgical booking to ultimately avoid insurance claim denials. These included BMI, certain demographic factors, CCI ≥ 4, and patients 65 or older. Retrospective Cohort Study.

Risk factors of undiagnosed and uncontrolled hypertension in primary care patients with hypertension: a cross-sectional study

BackgroundHypertension is a common heart condition in the United States (US) and severely impacts racial and ethnic minority populations. While the understanding of hypertension has grown considerably, there remain gaps in US healthcare research. Specifically, there is a lack of focus on undiagnosed and uncontrolled hypertension in primary care settings.AimThe present study investigates factors associated with undiagnosed and uncontrolled hypertension in primary care patients with hypertension. The study also examines whether Black/African Americans are at higher odds of undiagnosed and uncontrolled hypertension compared to White patients.MethodsA cross-sectional study was conducted using electronic health records (EHR) data from the University of Utah primary care health system. The study included for analysis 24,915 patients with hypertension who had a primary care visit from January 2020 to December 2020. Multivariate logistic regression assessed the odds of undiagnosed and uncontrolled hypertension.ResultsAmong 24,915 patients with hypertension, 28.6% (n = 7,124) were undiagnosed and 37.4% (n = 9,319) were uncontrolled. Factors associated with higher odds of undiagnosed hypertension included age 18–44 (2.05 [1.90–2.21]), Hispanic/Latino ethnicity (1.13 [1.03–1.23]), Medicaid (1.43 [1.29-1.58]) or self-pay (1.32 [1.13-1.53]) insurance, CCI 1-2 (1.79 [1.67-1.92]), and LDL-c ≥ 190 mg/dl (3.05 [1.41–6.59]). For uncontrolled hypertension, risk factors included age 65+ (1.11 [1.08–1.34]), male (1.24 [1.17–1.31]), Native-Hawaiian/Pacific Islander (1.32 [1.05-1.62]) or Black/African American race (1.24 [1.11-1.57]) , and self-pay insurance (1.11 [1.03-1.22]).ConclusionThe results of this study suggest that undiagnosed and uncontrolled hypertension is prevalent in primary care. Critical risk factors for undiagnosed hypertension include younger age, Hispanic/Latino ethnicity, very high LDL-c, low comorbidity scores, and self-pay or medicaid insurance. For uncontrolled hypertension, geriatric populations, males, Native Hawaiian/Pacific Islanders, and Black/African Americans, continue to experience greater burdens than their counterparts. Substantial efforts are needed to strengthen hypertension diagnosis and to develop tailored hypertension management programs in primary care, focusing on these populations.

Positive Trends in Racial Disparities for Head and Neck Microvascular Reconstructive Surgery.

To evaluate national trends in racial disparities for patients undergoing head and neck reconstructive surgery. Retrospective analysis using the 2008 to 2021 American College of Surgeons National Surgical Quality Improvement Program database. Patients receiving microvascular free tissue transfer were eligible for inclusion. Pediatric patients and those treated by non-otolaryngologists were excluded. Outcomes were analyzed with univariate and multivariable models. A total of 5831 head and neck free flap cases were analyzed, 4869 (83.5%) were White, 560 (9.6%) were Black or African American, and 402 (6.9%) were Asian, Native American, or other groups (ANAOG). The proportion of Black or African American patients and ANAOG patients undergoing free tissue transfer increased significantly over the time period (p = 0.047 and p = 0.010, respectively). However, there was a downtrend that started around 2017. In a multivariable model, Black or African American race was not associated with readmission (OR = 0.99 [95% CI 0.74, 1.31], p > 0.05), returning to the operating room (OR = 1.20 [95% CI 0.96, 1.49], p > 0.05), or any post-operative complication (OR = 0.83 [95% CI 0.68, 1.01], p > 0.05). There were also no significant associations found in the ANAOG population on multivariate analysis (p > 0.05 for all). The percentage of free tissue transfer performed in patients from minority backgrounds with head and neck cancer has been increasing in the United States. Outcomes after head and neck microvascular reconstruction are similar when stratified by race. However, racial disparities remain and further work is necessary to reduce these disparities. Level IV Laryngoscope, 2024.

Factors associated with change in activities of daily living performance in home health care patients with diabetes

Older adults with diabetes are at risk for impairments in activities of daily living (ADL) performance. Home health (HH) services help patients regain their ability to perform ADLs following hospitalization, but there may be disparities in ADL improvement. We aimed to identify factors associated with change in ADL performance from the start of HH care to discharge in HH patients with diabetes age ≥65. This secondary analysis used Outcome and Assessment Information Set-D data collected by a HH agency. The sample (n = 1350) had a mean age of 76.3 (SD 7.3). Black/African American race and bowel incontinence/ostomy were associated with less ADL improvement. The following factors were associated with greater ADL improvement: having a caregiver who needed training/support, surgical wounds, pain that interfered with activity, confusion, and better scores in prior functioning. Overall, most patients improved their ADL performance while receiving HH care, but there are disparities that should be addressed.

Longitudinal Transition of Symptom Cluster Profiles Among Community-Dwelling Older Adults With Heart Failure.

Older adults with heart failure experience clustered symptoms. However, little is known about how symptom clusters transition over time. This study aimed to (1) identify the longitudinal transition of symptom cluster profiles over 8 years and (2) examine the associations between demographic and clinical factors and the transition between symptom cluster profiles over time. We conducted a longitudinal secondary analysis of data from the Health and Retirement Study's 2008, 2012, and 2016 surveys. We included participants with heart failure in the core data sets and their proxy respondents in the exit data sets. We included demographic and clinical variables as well as six symptoms (fatigue, shortness of breath, pain, swelling, depressive symptoms, dizziness) through physical health interviews. We used latent transition analysis and multinominal regressions to determine longitudinal profiles and explored the association between demographic and clinical factors and membership in symptom cluster profiles. Among 690 participants, we found four symptom cluster profiles (high burden, low burden, distressing, and respiratory-depressive distress). Participants in the low burden at baseline had the highest probability of transitioning to the respiratory-depressive distress profile. Participants in the respiratory-depressive distress at 4 years had the highest probability of transitioning to the high burden profile. Male sex, Black/African American race, smoking, and comorbidities were associated with the increased odds of transiting from the low symptom burden to the high symptom burden profile. Symptom cluster profile memberships were stable over an 8-year period. However, symptom cluster profiles are changeable and deteriorate over time. Identifying predictive factors enables targeted interventions for those at highest risk.

Du Boisian sociology after Du Bois: Frazier, St Clair Drake, and the global and comparative study of race and empire

AbstractIn this paper, I focus on two thinkers who I contend can be read as Du Boisian sociologists: Franklin Frazier and John Gibbs St. Clair Drake. I argue that both Frazier and Drake are often (mis)represented as being ethnographic sociologists of racism in the American inner city who owe their intellectual training and lineage to the Chicago School. By contrast, I argue that Frazier and Drake, while interested in race in the American inner city, both viewed American racism as only one piece in a global jigsaw puzzle; both advocated for comparative and historical sociologies of race and empire which would highlight—to quote Frazier (1973, 339)—that although racism “in the United States has many unique features, it is […] a phase of a world process.” Excavating this world process, to both Frazier and Drake, necessarily entailed studying the global color line beyond its expression only in the United States. Frazier and Drake ought to be read, therefore, primarily as Du Boisian sociologists, not simply as parochial ethnographers of the inner city. The data for this paper come from the Du Bois, Frazier, and Drake papers housed in archives at the University of Massachusetts‐Amherst, Howard University, and the Schomburg Centre.

Work absence and productivity loss of patients undergoing a trial of spontaneous passage for ureteral stones.

Patients with ureteral stones are often managed with a spontaneous trial of passage. While cost effective, the current literature has not examined the effects of a trial of passage on patients' work productivity. In this study, we aim to characterize work absence and productivity losses in a cohort of patients undergoing a trial of passage for ureteral stones. Actively employed patients aged 18 to 64 and discharged from Duke emergency departments without surgical intervention for ureteral stones ≤ 10mm were contacted by phone four weeks after their presentation. Participants completed the Institute for Medical Technology Assessment Productivity Cost Questionnaire which assesses three domains: absenteeism - missed work; presenteeism -productivity when returning to work; and unpaid work - assistance with household work. Linear regression associated demographic and stone factors with productivity losses.109 patients completed the survey. In total, 67% of patients missed work, 46% had decreased productivity when returning to work, and 55% required assistance with unpaid work. 59% of patients with stones ≤ 5mm missed work versus 84% with stones > 5mm (p = 0.009). African American race (coefficient 23.68, 95% confidence interval 2.24-45.11, p = 0.031), first-time stone formers (coefficient 20.28, 95% confidence interval 2.50-38.07, p = 0.026), and patients with stones > 5mm (coefficient 25.34, 95% CI 5.25-45.44, p = 0.014) were associated with increased productivity losses. The majority of patients miss work while undergoing a trial of passage and many have decreased productivity when returning to work. This information may help counsel patients in emergency departments, especially first-time stone formers, and prevent return visits.