Racial Disparities In Diagnosis Research Articles

52568 Racial Disparities in Diagnosis, Management, and Outcomes of Anogenital Squamous Cell Carcinoma in Male Patients

52568 Racial Disparities in Diagnosis, Management, and Outcomes of Anogenital Squamous Cell Carcinoma in Male Patients

Cognitive training for schizophrenia: Do race and ethnicity matter?

Racial disparities in diagnosis, treatment, and outcome have been well-established for people with schizophrenia. While cognitive remediation treatments have been shown to produce mild to moderate improvements in cognition for people with schizophrenia, few studies have examined racial/ethnic differences in treatment response. This study employed a secondary analysis of data from two randomized, single-blind controlled trials (N = 119) investigating the efficacy of two forms of cognitive training, to explore potential racial/ethnic differences in targeted outcomes. Given the extant literature, we predicted that racial/ethnic minorities would (1) drop out of the study at higher rates, (2) display greater levels of functional and cognitive impairment prior to treatment, and (3) display lower levels of improvement in cognitive and functioning outcomes following treatment. Our study revealed largely negative findings: white vs. non-white groups showed similar treatment drop-out rates, similar levels of cognitive impairment and symptom severity at study baseline and showed similar responses to cognitive training, with the exception of working memory in which participants' racial/ethnic minority status predicted significantly greater improvement in response to cognitive training. These findings suggest that cognitive remediation treatments are effective at addressing cognitive deficits in racial/ethnic minorities and supports cognitive remediation as a treatment which may help address racial/ethnic disparities in cognition. Given the scant research literature, future analyses should look at race as a potential mediator of treatment in a variety of evidence-based psychosocial treatments.

Racial Implicit Associations in Child Psychiatry

Racial disparities in diagnosis and treatment are prevalent in child psychiatry, including disparate diagnosis rates of internalizing and externalizing disorders in Black and White children. However, limited research has investigated mechanisms that contribute to these disparities. This study examined child racial implicit associations in psychiatric clinicians and medical students to address this gap. Psychiatrists and trainees completed an online survey including two race Implicit Association Tests (IATs) pairing child faces to words with either positive or negative valence, and words related to internalizing or externalizing behavioral problems. We further investigated psychiatrists and trainees' demographic predictors of implicit associations. Data was analyzed from 235 psychiatrists and trainees (112 child and adolescent psychiatrists and fellows) who met inclusion criteria. Psychiatrists and trainees demonstrated greater moderate-to-strong association between Black child faces and "bad" words (44.3%) versus "good" words (6.4%), and between externalizing words (41.7%) versus internalizing words (7.2%). Psychiatrists and trainees' demographic characteristics including being female (β = -0.12; 95% CI = -0.23 to -0.01; p<0.05), Black (β = -0.36; 95% CI = -0.54 to -0.18; p<0.001), or an attending physician (β = -0.26; 95% CI = -0.45 to -0.06; p=0.01) were significant predictors of decreased association between Black child faces and negative valance words. Being female was a significant predictor of decreased association between Black child faces and externalizing words (β = -0.26; 95% CI = -0.45 to -0.06; p=0.01). Participating psychiatrists and trainees demonstrated bias towards associating Black rather than White child faces with negative words and externalizing behavioral problems. Future research should examine 1) racial implicit associations in a more generalizable sample, 2) the relationship between race IATs and provider behavior, and 3) interventions to reduce racial inequities in psychiatry, including individual and systemic solutions. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science.

Racial Disparities in Diagnosis and Treatment of Depression Associated with Androgen Deprivation Therapy for Prostate Cancer

To analyze potential racial disparities in the diagnosis and management of depression associated with androgen deprivation therapy. TriNetX health record network was queried for prostate cancer patients treated with androgen deprivation therapy from 2003-2023. Differences in rates of depression diagnosis and treatment were compared between White and Black patients. Means, odds ratios, and t tests were calculated in univariate analysis with 95% confidence intervals (CI). Data were queried from 93 health care organizations to yield 78,313 prostate cancer patients treated with androgen deprivation therapy. Patients on androgen deprivation therapy had 60% greater odds of developing depression vs other patients [9% vs 6%; odds ratio (OR) 1.6; 95% CI (1.5-1.7); P <.0001]. Of those with depression secondary to androgen deprivation therapy, only 35% were treated with antidepressants. After starting androgen deprivation therapy, White patients had 30% greater odds of being diagnosed with depression, compared to Black patients [10% vs 8%; OR 1.3; 95% CI (1.2-1.4);P <.001]. White patients also had higher odds of being treated with a first line antidepressant than Black patients [56% vs 48%; OR 1.4, 95% CI (1.2-1.6),P <.001]. This analysis confirms a significant association between androgen deprivation therapy and the development of clinical depression, and highlights its medical undertreatment. Importantly, our findings also indicate significant racial disparities in the identification and treatment of depression. Routine screening initiatives that account for social determinants of health may alleviate this disparity. Limitations of this study include retrospective design and lack of data describing severity of depression, which might correlate with need for medication.

Racial Disparities in Diagnosis and Treatment of Patients With Dermatomyositis of Different Skin Tones.

Delays in the diagnosis and treatment of dermatological conditions in minorities are a well-documented health disparity. We aimed to determine if there was a delay in detection and treatment initiation for dermatomyositis (DM) and amyopathic dermatomyositis (ADM) in patients of different skin tones. Patients from Montefiore Medical Center who met the criteria for DM and ADM were included in this cohort study. Records were reviewed for date of first documented rash, creatine kinase levels, muscle weakness complaints, and date of first steroid or disease-modifying antirheumatic drug initiation. The median number of days between rash documentation and therapy initiation was compared for patients of different races, including non-Hispanic White, non-Hispanic Black, Hispanic, and other (Asian and unknown). Data were compared in White versus non-White skin. Sixty-three DM and 9 ADM patients met the inclusion criteria. There was a shorter time to treatment initiation in White versus non-White patients, with a median number of 8 days compared with 21 days, respectively ( p = 0.05). Kaplan-Meier curves showed prolonged time to diagnosis and treatment in all other races when compared with White patients ( p = 0.03). It took clinicians longer to diagnose and treat DM and ADM in patients of color. The trends observed emphasize the importance of increasing dermatology education of non-White skin to improve detection and treatment of DM and ADM and minimize health disparities.

Racial differences in pathways to care preceding first episode mania or psychosis: a historical cohort prodromal study.

There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients. Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White). A total of 205 (FEM = 74; FEP = 131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2 ± 4.3 vs. 7.4 ± 6.6 years; p < 0.001) with an older age at time of first visit for a mental health complaint (15.7 ± 6.3 vs. 11.1 ± 6.0 years; p = 0.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use. These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.

Racial disparities in diagnosis of invasive melanoma among veterans: A comparative analysis with the Surveillance, Epidemiology, and End Results Program

Racial disparities in diagnosis of invasive melanoma among veterans: A comparative analysis with the Surveillance, Epidemiology, and End Results Program

0554 Racial Disparities in Healthcare Resource Utilization among Older Adult Medicare Beneficiaries With Comorbid OSA and Depression

Abstract Introduction Depression and obstructive sleep apnea (OSA) are highly comorbid and independently associated with increased economic burden. Evidence suggests important racial disparities in diagnosis and treatment of each condition. This study sought to evaluate the economic burden of occult OSA among Black and White older adults with depression. We hypothesized that the impact of occult OSA on healthcare resource utilization would differ by race. Methods Data were derived from a 5% sample of Medicare administrative claims data. Inclusion criteria were age &amp;gt;64 years, 12 months continuous enrollment prior to OSA diagnosis, depression, and Black or White race. Undiagnosed OSA and pre-existing depression were defined using ICD-10 codes during the 12 months prior OSA diagnosis. HCRU was defined as monthly counts of inpatient, outpatient, and emergency department (ED) visits in each of the 12 months before OSA diagnosis. The relationship between undiagnosed OSA and HCRU was modeled using negative binomial regression. Inverse probability of treatment (IPT) weighting was used to balance covariates between groups. Effect modification by race was evaluated using an interaction term; estimates were stratified by race. Results Of 39,192 beneficiaries with pre-existing depression, 4,353 suffered undiagnosed OSA (n=325 Black adults, 7.5%). Relative to White beneficiaries with undiagnosed OSA, Black beneficiaries with undiagnosed OSA were more likely to be female (76.6% vs. 68.6%, p=.002) and to suffer multimorbidity (&amp;gt;7 comorbid conditions [71.7% vs 52.7%, p&amp;lt;.001]). In IPT weighted models and relative to Black non-sleep disordered controls, Black beneficiaries with undiagnosed OSA had higher inpatient (RtR 1.89; 95% CI 1.33, 2.71), outpatient (RtR 1.38; 95% CI 1.04, 1.83) and ED (RtR 1.83; 95% CI 1.22, 2.75) utilization. Relative to White non-sleep disordered controls, White beneficiaries with undiagnosed OSA demonstrated higher inpatient (rate ratio (RtR) 1.51; 95% CI 1.38, 1.65)), outpatient (RtR 1.18; 95% CI 1.10, 1.26) and ED (RtR 1.45; 95% CI 1.34, 1.57) utilization. The interaction between race and undiagnosed OSA was significant in all models (p&amp;lt;.001). Conclusion Among Medicare beneficiaries with pre-existing depression, comorbid undiagnosed OSA is associated with increased HCRU across multiple points of service. The strength of this association is greater among Black (vs White) beneficiaries. Support (if any) ResMed Foundation

Racial Disparities in Diagnosis and Management of Benign Prostatic Hyperplasia: A Review.

We sought to perform a contemporary literature review highlighting the racial disparities which exists in the evaluation and management of benign prostatic hyperplasia (BPH). Current literature suggests that racial disparities exist in the diagnosis of BPH and treatment lower urinary tract symptoms (LUTS). This is seen in the presentation and diagnosis of the disease as well as a difference in preventative care with discordant incidences of medical and surgical management among racial groups. The racial disparities that exist in the diagnosis and management of BPH and LUTS require further investigation to better identify the underlying causes. This will ultimately allow for continued improvement in care delivery and a more personalized approach in patient management.

35P Racial disparities in diagnosis, histological type, treatment and survival in ovarian cancer patients in the US from 1992 to 2018: SEER-based analysis

Ovarian malignancies are the 7th diagnosed malignancy and the 8th cause of death in females worldwide. Ovarian cancer includes a great heterogeneous group of neoplasms that differs in histological type, pathological stage, risk factors, prognosis, and treatment. Racial disparities in incidence, treatment, and mortality in cancers exist globally. With Surveillance, Epidemiology, and End Results (SEER) program in place, detection of these disparities would be feasible. herein racial disparities in ovarian cancer are analyzed.

Racial and regional disparities in metastatic breast cancer.

10516 Background: Breast cancer is the most commonly diagnosed malignancy in American women, with about 281,500 new reported cases this year, 3.8 million women living with an active or history of breast cancer, and a lifetime occurrence of 1 in 8 women in this nation. Racial disparities persist despite the advent and implementation of screening by national agencies. AA females are less likely to be diagnosed with breast cancer, and yet bear an arbitrarily high burden of mortality of this malignancy. Socioeconomic variables and lifestyle are the most plausible explanations of this discrepancy. Even in clinical trials, there remains an underrepresentation of all ethnic minorities. Encouragement of guideline based screening for all along with constant follow ups, access to health insurance and a more uniform representation in trials are the cornerstone of eliminating these disparities. Methods: Data for this study was obtained from the 2016-18 Nationwide Inpatient Sample (NIS) which comprises 20% of the total US hospital discharges. We identified all patients with a primary diagnosis of Malignant Neoplasms of Breast. In-hospital mortality, race and hospital regions for the given patients were studied. Baseline characteristics of participants were summarized using descriptive statistics. The patient population was stratified as per race, hospital region, gender, therapy they received and family history. Logistic regression was performed to derive the odds ratio while adjusting for different variables. Further details: https://www.hcup-us.ahrq.gov/ . Results: 99, 543 patients with metastatic breast cancer were identified, and almost 99% of them were females. 67% of the population was comprised of Caucasians, 16.91% African Americans (AA), 9.14% Hispanics and 3.28% Asians and Pacific Islanders (API). AAs had the most reported deaths at 5.54%, followed by APIs at 4.80% and Caucasians 4.09% (p &lt; 0.0001). The odds of dying were significantly higher in AA population when compared to Caucasian population (OR 1.391 (1.286-1.504)), and the odds were consistently higher across all regions of the US. In terms of regional variation, it was seen that races identifying as “others' ' had significantly higher odds of dying in the North East (OR 1.646 (1.238-2.189)) and the West (OR 1.503 (1.059-2.133)). Conclusions: It is crucial to identify racial disparities in diagnosis, treatment and mortality before we devise a blueprint to tackle this incongruity. This highlights the significance of universal screening and better health insurance coverage in addition to recognition of reasons behind these differences.

0376 Evaluation of healthcare delivery disparities among the Native American population: Knowledge and Attitudes of obstructive sleep apnea among the Indian Health Services primary care physicians

Abstract Introduction The burden of racial disparities in diagnosis and treatment of Obstructive sleep apnea (OSA) remains underrecognized among the Native American population. This study intends to assess the knowledge and attitudes towards diagnosis and management of obstructive sleep apnea among the primary care physicians caring for the Native American population. Methods A cross-sectional survey was conducted at an Indian Health Services (IHS) primary care clinic. A validated OSA Knowledge (18 questions) and Attitudes (5 questions) (OSAKA) questionnaire was used, in addition to one question to address referrals to a sleep specialist. Results A total of 20 primary care providers were invited to participate in the survey with a response rate of 45% (9 participants, 2 males and 7 females). The median (IQR) knowledge score was 14 (13-16). The mean (±SD) percentage of correct response (proportion of correctly answered questions) was 79% (±9.5), which was similar to previously reported scores among primary care physicians in other studies. There was no significant knowledge difference between males and females and no difference based on age. All participants felt it was very or extremely important to identify patients with OSA and that OSA is important as a clinical disorder. There was a significant positive correlation between knowledge and recognizing the importance of OSA as clinical disorder, and between knowledge and confidence in identification of OSA. There was a negative correlation between confidence in OSA identification and referral to a sleep specialist but was not statistically significant. Only one participant (11%) felt comfortable managing patients on CPAP therapy, but there was no significant correlation with referrals to a sleep specialist. Conclusion Obstructive sleep apnea knowledge in IHS primary care providers is comparable to their peers. However, the lack of comfort in managing patients with OSA on CPAP did not increase referrals to a sleep specialist. This highlights a possible disparity and resource gap in treating Native Americans within the IHS health system with sleep apnea and further studies are needed. Support (If Any)

Racial Disparities in Diagnosis, Management, and Outcomes in Preeclampsia.

Racial disparities are prevalent in many aspects of obstetric care in the USA. Non-Hispanic black women have a higher prevalence of the diagnosis of hypertensive disorders of pregnancy in addition to associated morbidity and mortality. The purpose of this review is to review current data regarding racial disparities in the diagnosis and management of hypertensive disorders of pregnancy. Diagnosis of hypertensive disorders of pregnancy is more common among non-Hispanic black women even after adjustment for comorbidities. Furthermore, prevalence of severe morbidity among those with hypertensive disorders of pregnancy is increased in non-Hispanic black women, including cardiovascular events related. Proposed management solutions include quality improvement initiatives, telehealth, and strategies to reduce both structural racism and implicit bias. Racial disparities exist in both diagnosis and management of hypertensive disorders of pregnancy; further innovative work is needed to reduce these disparities.

Characterizing idiopathic intracranial hypertension socioeconomic disparities and clinical risk factors: A retrospective case-control study

IntroductionAgainst the backdrop of the diverse minority-majority state of Hawaii, this study seeks to better characterize associations between idiopathic intracranial hypertension (IIH) with sociodemographic variables and medical comorbidities. MethodsA retrospective case-control study was conducted by utilizing 54 IIH patients and 216 age-, sex-, and race-matched controls, 216 unmatched controls, and 63 age-, sex-, and race-matched migraine patients. ResultsRelative to controls, IIH were 25 years younger (p < 0.0001) and 10.18 kg/m2 heavier (p < 0.0001), as well as exhibited greater odds of the following variables (p < 0.05): female (odds ratio [OR]: 8.87), the lowest income quartile (OR: 2.33), Native Hawaiian or other Pacific Islander (NHPI; OR: 2.23), Native American or Alaskan Native (OR: 16.50), obesity class 2 (35.0–39.9 kg/m2; OR: 4.10), obesity class 3 (>40 kg/m2; OR: 6.10), recent weight gain (OR: 11.66), current smoker (OR: 2.48), hypertensive (OR: 3.08), and peripheral vascular disease (OR: 16.42). Odds of IIH were reduced (p < 0.05) for patients who were Asian (OR: 0.27) or students (OR: 0.30;). Unique from Whites, NHPI IIH patients exhibited greater odds (p < 0.05) for being from lower socioeconomic status and currently smoking, as well as potential association with seizures (p = 0.08). Compared to migraines, IIH headaches were at increased odds of occurring (p < 0.05) occipitally, for greater than 15 days per month, aggravated by postural changes, and comorbid with dizziness and tinnitus. ConclusionsThese results not only better characterize IIH, but also highlight socioeconomic and racial disparities in diagnosis.

The Impact of Residential Racial Segregation on Non-Small Cell Lung Cancer Treatment and Outcomes

BackgroundDespite decreases in lung cancer incidence, racial disparities in diagnosis and treatment persist. Residential segregation and structural racism have effects on socioeconomic status for black people, affecting health care access. This study aims to determine the impact of residential segregation on racial disparities in non-small cell lung cancer (NSCLC) treatment and mortality. MethodsPatient data were obtained from Surveillance, Epidemiology, and End Results Program database for black and white patients diagnosed with NSCLC from 2004-2016 in the 100 most populous counties. Regression models were built to assess outcomes of interest: stage at diagnosis and surgical resection of disease. Predicted margins assessed impact of index of dissimilarity (IoD) on these disparities. Competing risk regressions for black and white patients in highest and lowest quartiles of IoD were used to assess cancer-specific mortality. ResultsOur cohort had 193,369 white and 35,649 black patients. Black patients were more likely to be diagnosed at advanced stage than white patients, with increasing IoD. With increasing IoD, black patients were less likely to undergo surgical resection than white patients. Disparities were eliminated at low IoD. Black patients at high IoD had lower cancer-specific survival. ConclusionsBlack patients were more likely to present at advanced disease, were less likely to receive surgery for early stage disease, and had higher cancer-specific mortality at higher IoD. Our findings highlight the impact of structural racism and residential segregation on NSCLC outcomes. Solutions to these disparities must come from policy reforms to reverse residential segregation and deleterious socioeconomic effects of discriminatory policies.

Race impacts concussion

Over the past decade The Journal of Pediatrics and other journals have published an abundance of studies on youth concussion, often with a focus on sports-related concussion. Pediatricians have thus become increasingly familiar with the diagnosis and management of concussion, and our children have no doubt benefitted from attention to what was a previous neglected injury. But, how well do we understand the mechanism of injury? Do all children suffer the same mechanism for concussion? In this volume of The Journal, Wallace and Mannix present a retrospective, cross-sectional study of emergency department (ED) visits between 2010-2015 by children less than or equal to age 19 for concussion, using the National Hospital Ambulatory Medical Care Survey. Falls were close to twice as common as sports as the underlying mechanism of injury at ED visits. Compared with non-Hispanic White pediatric patient visits for concussion, non-Hispanic Black patients were significantly less likely to present to an ED for concussion. Although assault was a less common mechanism at ED visits compared with falls, sports, and motor vehicle accidents, the odds of non-Hispanic Black and some other race/ethnicity children and adolescents sustaining a concussion from assault was roughly 4-fold higher compared with sport (Table).TablePopulation-weighted frequencies of concussion/MHT by mechanism of injury and race/ethnicity (n = 6 268 879)Mechanisms of injuryNon-Hispanic WhiteNon-Hispanic BlackHispanicOtherSport846 522 (23.4)213 372 (20.2)217 146 (15.4)17 124 (9.6)Motor vehicle collision445 177 (12.3)142 303 (13.5)141 715 (10.1)8474 (4.7)Fall1 495 782 (41.3)407 490 (38.5)816 569 (57.9)98 259 (55.1)Assault125 579 (3.4)131 762 (12.5)11 618 (0.8)12 403 (6.9)Other accident710 238 (19.6)161 791 (15.3)223 224 (15.8)42 331 (23.7)Values are number (%). Open table in a new tab Values are number (%). Although the study data are examined retrospectively, biased possibly by coding in the database, and influenced perhaps by factors affecting how children of different races present to and utilize the ED, the findings regarding the mechanism of injury are nevertheless striking. Youth concussion in the ED is not an injury restricted to children privileged to play organized sports, but instead overwhelmingly an injury from trauma by falls, motor vehicle accidents, and assault. Racial disparities affect the likelihood of the particular underlying mechanism. Youth concussion is much more than a sports phenomenon. Perhaps we should reconsider our allocation of public health resources and research funding for youth concussion. Article page 249 ▸ Racial Disparities in Diagnosis of Concussion and Minor Head Trauma and Mechanism of Injury in Pediatric Patients Visiting the Emergency DepartmentThe Journal of PediatricsVol. 233PreviewTo determine if racial/ethnic differences exist in the diagnosis and mechanism of injury among children and adolescents visiting the emergency department (ED) for concussion and minor head trauma (MHT). Full-Text PDF

Racial Disparities in Developmental Delay Diagnosis and Services Received in Early Childhood.

Racial disparities in diagnosis and receipt of services for early childhood developmental delay (DD) are well known but studies have had difficulties distinguishing contributing patient, healthcare system, and physician factors from underlying prevalence. We examine rates of physician diagnoses of DD by preschool and kindergarten entry controlling for a child's objective development via scoring on validated developmental assessment along with other child characteristics. We used data from the preschool and kindergarten entry waves of the Early Childhood Longitudinal Study, Birth Cohort. Dependent variables included being diagnosed with DD by a medical provider and receipt of developmental services. Logistic regression models tested whether a child's race was associated with both outcomes during preschool and kindergarten while controlling for the developmental assessments, as well as other contextual factors. Among 7950 children, 6.6% of preschoolers and 7.5% of kindergarteners were diagnosed with DD. Of preschool children with DD, 66.5% were receiving developmental services, while 69.1% of kindergarten children with DD were receiving services. Children who were Black, Asian, spoke a primary language other than English and had no health insurance were less likely to be diagnosed with DD despite accounting for cognitive ability. Black and Latinx children were less likely to receive services. Racial minority children are less likely to be diagnosed by their pediatric provider with DD and less likely to receive services despite accounting for a child's objective developmental assessment. The pediatric primary care system is an important target for interventions to reduce these disparities.

Disparities in diagnosis, treatment and survival between Black and White Parkinson patients

IntroductionRacial disparities in diagnosis, treatment and survival in Black patients with Parkinson's disease (PD) compared to White patients have not been well studied, largely due to limited number of studies and information on Black patients in healthcare systems. Studying racial disparities and identifying underlying factors in large populations are important to understand PD and improve care. MethodsWe retrospectively identified PD patients on both races from 1/1/2006 to 10/31/2017 and compared demographics, socioeconomic status (educations, incomes and insurances), comorbidities (all categories, including mood, cognition and psychosis), treatment (medications for parkinsonism and major non-motor symptoms, and frequency and locations of healthcare) and survival, and identified factors associated with medication usage and survival. ResultsWe retrospectively studied 2033 PD patients, of whom 725 were Black. Black patients lacked male predominance, were 4 years older at first diagnosis here, more likely to smoke and live in a low education and income community, and possessed limited insurances compared to White patients. Black patients also had more comorbidities and were more likely to receive care through emergency or inpatient service, but less likely to be on medications for parkinsonism and mood disorders. Race, age, smoking status, insurance type, frequency and locations of healthcare and comorbidities were associated with medication usage. Black race, older age, inpatient admission and malignancy were associated with increased risk of death. ConclusionWe revealed racial disparities in diagnosis, treatment and survival, and factors associated with medication usage and survival in the largest reported Black PD cohort from a single center.

Racial Disparities in Diagnosis of Attention-Deficit/Hyperactivity Disorder in a US National Birth Cohort

There are limited data on the racial disparities in the incidence of attention-deficit/hyperactivity disorder (ADHD) diagnosis in children at the national level. To explore differences in rates of diagnosis of ADHD and use of treatment among children by race and ethnicity. This retrospective cohort study assessed insurance claims data of children born in the US between January 1, 2006, and December 31, 2012, who had continuous insurance coverage for at least 4 years. The last date of follow-up included in the cohort was June 30, 2019. Race/ethnicity designations were based on self-report and included non-Hispanic White, Black, Hispanic, and Asian. Data were analyzed between October 2019 and December 2020. Race and ethnicity. ADHD diagnosis as defined by International Classification of Diseases codes (ninth or tenth editions) and treatment within 1 year of diagnosis, including medication and behavior therapy as defined by billing codes. Data on ADHD diagnosis and treatment were adjusted for sex, region, and household income in a multivariate Cox regression model. Among 238 011 children in the cohort (116 093 [48.8%] girls; 15 183 [6.7%] Asian, 14 792 [6.2%] Black, 23 358 [9.8%] Hispanic, and 173 082 [72.7%] White children), 11 401 (4.8%) were diagnosed with ADHD. The cumulative incidence at age 12 was 13.12% (95% CI, 12.79%-13.46%). In multivariate Cox regression adjusting for sex, region, and household income, the hazard ratio for Asian children was 0.48 (95% CI, 0.43-0.53); Black children, 0.83 (95% CI, 0.77-0.90); and Hispanic children, 0.77 (95% CI, 0.72, 0.82) compared with White children. In the first year after diagnosis, 516 preschool children (19.4%) received behavioral therapy only, 860 (32.4%) had medications only, 505 (19.0%) had both, and 774 (29.2%) had no claims associated with either option. A higher percentage of school-aged children (2904 [65.6%]) were prescribed medications, and fewer had therapy only (639 [14.4%]) or no treatment at all (884 [20.0%]). Compared with other groups, White children were more likely to receive some kind of treatment. Asian children had the highest odds of receiving no treatment (odds ratio compared with White children, 0.54; 95% CI, 0.42-0.70). Racial and ethnic disparities in the diagnosis and treatment of ADHD are evident. Future study is needed to elucidate the mechanism behind these disparities, with special attention to Asian children. Clinicians should provide racially sensitive care in the evaluation and treatment of ADHD.

Racial Disparities in Diagnosis of Concussion and Minor Head Trauma and Mechanism of Injury in Pediatric Patients Visiting the Emergency Department

To determine if racial/ethnic differences exist in the diagnosis and mechanism of injury among children and adolescents visiting the emergency department (ED) for concussion and minor head trauma (MHT). A retrospective, cross-sectional study of patient (age ≤19years) visits to the ED for concussion between 2010-2015, using the National Hospital Ambulatory Medical Care Survey, was completed. The primary study exposure was race/ethnicity. Outcome measures included ED visits that resulted in a concussion/MHT diagnosisand mechanism of injury. Mechanism categories included sport, motor vehicle collision, fall, assault, and other mechanism. A multivariable logistic regression and multinomial logistic regression were conducted to assess relationships between race/ethnicity and outcomes. Findings were weighted to reflect population estimates. In total, 1263 child/adolescent visits for concussion/MHT were identified, representing an estimated 6.6 million child/adolescent visits nationwide. Compared with non-Hispanic White pediatric patients, non-Hispanic Black patients were least likely to have an ED visit for a concussion/MHT (P<.001; OR, 0.66; 95% CI, 0.52-0.83) The odds of non-Hispanic Black children/adolescents (OR, 3.80; 95% CI, 1.68-8.55) and children/adolescents of other race/ethnicity (OR, 4.93; 95% CI, 1.09-22.23) sustaining a concussion/MHT resulting from assault vs sport was higher. Amid the emerging focus on sport-related concussion, these ethnic/racial differences in ED diagnosis of concussion/MHT demonstrate sociodemographic differences that warrant further attention. Assault may be a more common mechanism of concussion among children/adolescents of a racial minority.