Underrepresented Minority Groups Research Articles

Abstract P339: The Clinical Application and Ancestral Diversity of Cardiometabolic Polygenic Risk Scores

Introduction: A polygenic risk score (PRS) is derived from a genome-wide association study (GWAS) and represents an aggregate of thousands of single-nucleotide polymorphisms (SNPs) that provide a baseline estimate of an individual’s genetic risk for a specific disease or trait at birth. Cardiometabolic disease represents a set of disease processes that historically have disproportionally affected underrepresented racial and minority groups. Furthermore, these groups represent a population generally not well captured by traditional risk scores compared to European cohorts. Since the first GWAS studying myocardial infarction was published, PRSs have increasingly been seen as a promising tool to improve risk stratification of non-European populations. However, how PRSs can be best used in clinical practice remains unclear. Hypothesis: We provide an overview of the PRSs related to cardiometabolic disease, analyze the ancestral diversity of GWAS cohorts, and discuss the evidence supporting their clinical applications. Methods: The Preferred Reporting Items For Systematic Reviews and Meta-analysis extension for Scoping Reviews protocol was used to conduct a scoping review of the MEDLINE, EMBASE, and CENTRAL databases. English studies that published a PRS related to atrial fibrillation (AF), cerebrovascular disease (CVD), coronary artery disease (CAD), dyslipidemia, heart failure, heritable cardiomyopathy, hypertension, and type 2 diabetes were reviewed. Results: Across the 4,863 studies screened, 82 articles met the inclusion criteria. The most common PRS related to CAD, followed by hypertension and CVD. Limited ancestral diversity was observed as most studies (56) included only individuals of European ancestry. A smaller proportion of studies (16) published PRSs derived in multi-ancestry cohorts. Only ten studies published a PRS derived solely from a sample population of non-European ancestry (Chinese, East Asian, Japanese, and Korean). The predictive performance of most PRSs was similar to or superior to traditional risk factors. More than half of the included studies (42) reported an integrated risk model combining a PRS with traditional risk factors or a clinical risk tool (FRS, PCE, CHADS2). The integrated risk model consistently improved predictive accuracy, but few studies investigated the performance in a non-European population. Conclusion: In conclusion, this scoping review reports strong evidence for the clinical use of PRSs in AF, CAD, CVD, and hypertension. However, most PRSs are derived in cohorts of European ancestry, which contributes to a lack of PRS transferability across different ancestral groups, likely exacerbating health inequities. Future prospective studies should focus on further establishing the clinical utility of PRSs. Additionally, diversity in future GWAS cohorts is essential to ensure that PRSs reflect the multi-ancestry society at large.

Long-term Effects of STEM Enrichment Programs on Wage Differentials Among Under-Represented Minority Students

This study focuses on the increasing disparities in STEM education achievement and long-term wage earnings of under-represented minority groups. As part of national efforts to improve the diversity of the STEM workforce, this study uses longitudinal data from the University of Houston’s Education Research Center (UH-ERC) to examine the effect of participation in a STEM focused intervention program (Houston-Louis Stokes Alliance for Minority Participation) on wage earnings across students from traditionally under-represented groups. Data analysis consisted of propensity score matching analysis, followed by an ordinal logistic regression model to measure program participation effects on wage earnings. Findings indicate a significant negative association between participation in STEM intervention program and long-term wage earnings. Results highlight the role of structural racism and human capital on perpetuating achievement and wage gaps across race and socio-economic status. Recommendations focus on career-preparedness as a tool to increase the human capital of under-represented groups, and institutional shifts in policy and program components that strive to reduce the impact of structural racism on this subpopulation of students.

Advocacy for Diversity in Hand Surgery.

Diversity in the Hand Surgery workforce improves the quality of care delivered, advances a wider variety of innovation within the field and leads to higher patient satisfaction, greater access to care and patient adherence to advice. An understanding of the data makes a compelling argument for change. Advocacy is necessary to stop the "leaky pipeline" of the loss of diversity in more senior and leadership roles. Hand surgeons who are both women and from underrepresented minority groups are especially vulnerable to bias from the health-care system, with focused support and mentoring required throughout their training and career.

Advice for Early Career Clinical Stroke Researchers Applying for National Institutes of Health Funding.

Advice for Early Career Clinical Stroke Researchers Applying for National Institutes of Health Funding.

Racial Disparities in Outcomes Following Open Treatment of Pediatric Femoral Shaft Fractures.

Introduction Femoral shaft fractures are a common pediatric injury that can require non-operative or operative management. Several studies have shown that race impacts pain management and a number of emergency department visits in the pediatric femur fracture population. This study aimed to investigate any association between pediatric patient race and number of comorbidities, 30-day postoperative outcomes, and length of stay following open surgical treatment of femoral shaft fractures. Methods Pediatric patients who underwent open treatment of femoral shaft fracture were identified in the National Surgical Quality Improvement Program-Pediatric database from 2012-2019. Patients were categorized into two cohorts: White and underrepresented minority (URM). URM groups included Black or African American, Hispanic, Native American or Alaskan, and Native Hawaiian or Pacific Islander. Demographics, comorbidities, and postoperative complications were compared using bivariate and multivariable regression analyses. Results Of the 5,284 pediatric patients who underwent open treatment of femoral shaft fracture, 3,650 (69.1%) were White, and 1,634 (30.9%) were URM. Compared to White patients, URM patients were more likely to have a higher American Society of Anesthesiologists score (p=0.012), more likely to have pulmonary comorbidities (p=0.005), require preoperative blood transfusion (p=0.006), and have an increased risk of prolonged hospital stay (OR 2.36; p=0.007). Conclusion Pediatric URM patients undergoing open treatment of femoral shaft fractures have an increased risk of extended hospital stay postoperatively compared to White patients. As the racial and ethnic constitution of the pediatric population changes, understanding racial and ethnic health disparities will be crucial to providing equitable care to all patients.

Applying A 'Mentor-Protégé Approach to Broadening Participation of HBCUs in the National Innovation Network

Innovation is one of the most important drivers of economic growth, yet only 8% of minorities, 12% of women, and < 0.05% of African Americans are recognized as innovators. However, a comprehensive analysis of nearly all doctoral dissertations from 1977 to 2015 shows that although individuals from under-represented minority groups demonstrated greater scientific innovation, their contributions are rarely further adopted compared to equally impactful contributions by majority groups. In this instance "rarely further adopted," as noted by Hofstra et al. (1), means that the "novel contributions by gender and racial minorities are taken up by other scholars at lower rates than novel contributions by gender and racial majorities, and equally impactful contributions of gender and racial minorities are less likely to result in successful scientific careers than for majority groups." Access to the wealth of potential innovations — going largely unnoticed and underutilized — from under-represented minority groups can be achieved, in part, by engaging science and engineering students, faculty, and staff at Historically Black Colleges and Universities (HBCUs) in entrepreneurship through the use of the Innovation Corps (I-Corps) curriculum with adaptations to fit the education and research environments at HBCUs. A consortium of three North Carolina universities and the NYC Regional Innovation Network (NYCRIN) I-Corps Node established a partnership developing a specialized Lean LaunchPad training program for HBCU students, faculty, and staff. Implementation followed a three-step train-the-trainers 'mentor-protégé model, where new instructors 'see one, do one, be one' while learning to deliver the curriculum. The overarching goals of this initiative are to evaluate the effectiveness of this approach in broadening participation in I-Corps and mainstreaming the innovation capacities of HBCUs. The authors include instructors from the collaborating institutions, who trained and served as the teaching team for regional and national cohorts. Included are the rationale for creating the program, partnership selection, instructor and team recruitment, best practices for the 'mentor-protégé model, and outcomes for the cohorts. This contribution is a unique opportunity for other faculty to learn from practitioners about the challenges and successes involved in creating such a new multi-institutional entrepreneurship training paradigm.

Inclusive Pathways to Invention: Racial and Ethnic Diversity Among Collegiate Student Inventors in a National Prize Competition

We present novel evidence from over 2,000 student inventors from colleges and universities across the United States who applied to a prestigious national prize. These unique data provide us with self-reported information about gender, race, and ethnicity for students earlier on the "pathway to invention" — young people who have already shown evidence of their inventiveness and are among those likely to be future patent holders. First, we show that 14% of prize applicants are from under-represented minority (URM) groups, which is a smaller gap than estimates of the racial/ethnic gap in patenting. We find striking differences in the focus of the inventions being created by URM inventors, particularly at the intersection of gender and race: URM men are much more likely than all other groups to work on consumer-oriented inventions and less likely to work on health care inventions. URM women are similar to non-URM students in being most likely to work on health care inventions. Differences by field of study show that URM men are more likely than other groups to come from business, and URM women are more likely to come from biological sciences. Finally, we show that slightly more URM applicants come from public research universities. A fruitful area for future research is examining the ways different types of universities support the development of URM students as inventors and contribute to URM students' continuation on the pathway to invention.

Dermatology Quality of Life Index scores in Bangladeshi patients with atopic eczema and their families in East London.

Atopic eczema (AE) is a chronic relapsing, pruritic disease that greatly affects the child and family's quality of life (QoL). It is usually common and severe among children of Bangladeshi ethnicity. This is a cross-sectional quantitative study in patients with AE of Bangladeshi origin, which aims to analyse different components of the family, children and adult quality-of-life indices and their relationship to patient age, sex, eczema severity and distribution, other allergic associations, parental education and socioeconomic level. Children and young adults of Bangladeshi origin aged 0-30 years, clinically diagnosed with AE were recruited as part of the Tower Hamlets Eczema Assessment project, a clinical phenotyping study of AE in the Bangladeshi population living in East London. Questionnaires completed by children/parents included the Family Dermatology Life Quality Index (FDLQI), Infant's Dermatology Quality of Life (IDQOL) and the Children's Dermatology Life Quality Index (CDLQI). Young adults completed the Dermatology Life Quality Index (DLQI). The disease severity was assessed objectively using the Eczema Area Severity Index (EASI). Patients and parents who did not read or speak English were aided by Bengali/Sylheti-speaking research assistants. Overall, 460 Bangladeshi children and 98 adults with AE were recruited. Burden of care, extra housework and emotional distress were the highest affected domains in parental QoL, while itching and sleep were the highest for children. Significant factors influencing FDLQI score were EASI [marginal effect (ME) 1.01, 95% confidence interval (CI) 1.00-1.03; P = 0.004], age (ME 0.98, 95% CI 0.97-0.99; P = 0.004), extensor eczema distribution (ME 1.25, 95% CI 1.03-1.52; P = 0.023), parental English fluency (ME 1.29, 95% CI 1.10-1.52; P = 0.002) and atopic comorbidities (ME 1.10, 95% CI 1.04-1.17; P = 0.001). Parental socioeconomic class was a nonsignificant factor. IDQOL/CDLQI was influenced significantly by the child's age (ME 0.99, 95% CI 0.97-1.00, P = 0.023), 'nonclear' eczema distribution clusters especially the 'severe extensive' cluster (ME 1.46, 95% CI 1.15-1.84; P = 0.002) and nonsignificantly by EASI and parental English literacy and socioeconomic levels. DLQI was affected significantly by nonclear eczema distribution groups especially 'severe extensive' (ME 2.49, 95% 1.76-3.53; P < 0.001) and nonsignificantly by patient age, and female sex. AE is a chronic disease where many external factors other than disease severity affect QoL of patients and their families, -especially in under-represented minority groups who face different linguistic and cultural barriers.

Racial disparities in dermatology.

Significant racial/ethnic disparities in dermatologic care and their subsequent impact on dermatologic conditions were recently reported. Contributing factors include socioeconomic factors, gaps in educational exposure, and underrepresentation of minority groups in the dermatologic workforce. In 2021, the American Academy of Dermatology (AAD) announced its three-year plan to expand diversity, equity, and inclusion in dermatology. One way to reduce disparities in dermatology is for every dermatologist, regardless of race or ethnicity, to receive adequate education in diseases, treatments, health equity, and tailored approaches to delivering dermatologic care with cultural humility. In addition, a diverse dermatologic workforce-especially at the level of residency program educators and organizational leaders-will contribute to improved cross-cultural understanding, more inclusive research efforts, and improved treatment approaches for conditions that are more prevalent or nuanced in certain racial/ethnic populations.Finally, thedermatology and broader healthcare community needs to acknowledgeand educateourselves on the health impacts of racism.

A Review of Mentorship in Urology: Are We Satisfied?

To evaluate the state of mentorship in the field of urology. Mentorship has been shown to decrease burnout, increase recruitment of underrepresented minority groups, and have a positive influence on the career trajectory of mentees. Approximately half of surgical residency programs have mentorship programs. The current literature supports the idea that formal mentorship programs are successful based on level 1 satisfaction scores. However, studies are sparse and of low quality. Mentorship program success is rarely objectively measured. Structured mentorship programs appear to be beneficial, but require serious planning, evaluation, and ongoing support without which the programs can fail. Future research should be focused on objective and measurable metrics of success.

Assessing and benchmarking equity, diversity, and inclusion in healthcare professions.

Healthcare professions are among the fastest growing careers in the United States, but the issues of equity, diversity, and inclusion remain a challenge. The percentage of underrepresented minority groups is disproportionately small despite many efforts to increase workforce diversity over the past several decades. As the demographics in our nation are rapidly changing, increasing racial, ethnic, and cognitive diversity is crucial to achieving a workforce with the capacity to provide accessible and equitable healthcare. Given the growing evidence that a diverse workforce improves healthcare outcomes, fosters unique perspectives (cognitive diversity), and helps to reduce health disparities, there is an urgent need to address perennial barriers such as structural racism, biases, and stereotypes. Educational institutions should be held accountable to integrate equity, diversity, and inclusion in all aspects of healthcare professions education and practice. This article discusses potential areas for innovation and opportunities that can be leveraged in assessing and benchmarking equity, diversity, and inclusion in healthcare professions. The ability to thoroughly assess the PA profession's culture in relationship to diversity, equity, and inclusion provides an opportunity to determine how well the profession is performing, and to strategically plan for what else need to be done.

Development of an At-Home COVID-19 Test Results-Reporting System for a School District Primarily Serving Underrepresented Minority Groups, San Diego, CA, 2021-2022.

School-sponsored at-home COVID-19 testing benefits users, school administrators, and surveillance efforts, although reporting results remains challenging. Users require simple systems with tailored posttest guidance, and administrators need timely positive test information. We built a system to serve these needs and to collect data for our Rapid Acceleration of Diagnostics-Underserved Populations Return to School Program study in San Diego County, California, from October 2021 through January 2022. We describe this system and our participant outreach strategies and outline a replicable model for at-home results reporting. (Am J Public Health. 2022;112(S9):S883-S886. https://doi.org/10.2105/AJPH.2022.307073).

Trends in Racial and Gender Profiles of United States Academic Emergency Medicine Faculty: Cross-Sectional Survey From 2007 to 2018

Background: Numerous studies have reported existing disparities in academic medicine. The purpose of this study was to assess racial and gender disparity in academic emergency medicine (EM) faculty positions across the United States from 2007 to 2018. Objective: The primary objective was to identify the racial and ethnic and gender distributions across academic ranks in EM. The secondary objective was to describe the racial and gender proportions across different tenure tracks and degrees. Methods: We conducted a retrospective analysis using data from the Association of American Medical Colleges. Simple descriptive statistics and time series analysis were employed to assess the trends and relationship between race and gender across academic rank, type of degree, and tenure status. Results: When averaged, 75% of all faculty members were White physicians and 67.5% were male. Asian faculty members showed an increased representation in the lower academic ranks and underrepresented minority groups demonstrated a small increase. Asian faculty members demonstrated a significantly increasing trend at the level of instructor (t = 0.02; p = 0.034; 95% CI 0.05–1.03). Female faculty members showed a significantly decreasing trend over the study period (t = –0.01; p < 0.001; 95% CI 0.68–0.75). White academic physicians and male faculty members made up most of all degree types and tenure categories. Conclusions: Despite an increase in proportional representation, the underrepresentation of female faculty members and those from minority groups persists in emergency medicine. Further studies are needed to identify and address the root causes of these differences.

Racial Disparities in Clinical Outcomes on Investigator-Initiated Breast Cancer Clinical Trials at an Urban Medical Center

BackgroundBlack women are 40% more likely to die of breast cancer compared to White women. Inadequate representation of Black patients in clinical trials may contribute to health care inequity. We aimed to assess breast cancer clinical outcomes in Non-Hispanic Black (Black) versus Non-Hispanic White (White) women with metastatic breast cancer (MBC) enrolled on investigator-initiated clinical trials at Winship Cancer Institute at Emory University, given the significant number of patients from underrepresented minority groups seen at Winship. Materials and MethodsBlack and White women with MBC on investigator-initiated trials at Emory between 2009 and 2019 were retrospectively evaluated. Univariate analyses and multiple logistic regression models were used to assess clinical response and treatment toxicities. Differences in overall survival between groups was assessed using quantile analysis. ResultsSixty-two women with MBC were included (66% White vs. 34% Black). Black patients had less clinical benefit from the trial therapy as only 57% had partial response or stable disease as best response compared to 78% of White women (P = .09). Quantile analysis showed significant difference in mean survival between Whites and Blacks by the end of follow up (64 vs. 38 months). There were no significant differences in toxicities between groups. ConclusionParticipation rates of Black women with MBC on investigator-initiated clinical trials at an urban cancer center were higher compared to key national trials. Black women had worse treatment response and survival. These results reinforce the need for assessment of tumor differences by ancestry and continued improvement in minority representation on clinical trials.

Diversity, equity, and inclusion in gastroenterology and hepatology: a survey of where we stand

In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. We developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. Of the 1219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n= 431 [35.4%]), in professional leadership (n= 340 [27.9%]), and among practicing GI and hepatology professionals (n= 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n= 545 [44.7%]), medical student opportunities (n= 520 [42.7%]), and program and professional society leadership roles for underrepresented racialand ethnic minority groups (n= 473 [38.8%]). Our survey explored imperative and timelyperspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.

Diversity, Equity, and Inclusion in Gastroenterology and Hepatology: A Survey of Where We Stand

In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. We developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. Of the 1219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n= 431 [35.4%]), in professional leadership (n= 340 [27.9%]), and among practicing GI and hepatology professionals (n= 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n= 545 [44.7%]), medical student opportunities (n= 520 [42.7%]), and program and professional society leadership roles for underrepresented racialand ethnic minority groups (n= 473 [38.8%]). Our survey explored imperative and timelyperspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.

Randomized Clinical Trials of Machine Learning Interventions in Health Care

Despite the potential of machine learning to improve multiple aspects of patient care, barriers to clinical adoption remain. Randomized clinical trials (RCTs) are often a prerequisite to large-scale clinical adoption of an intervention, and important questions remain regarding how machine learning interventions are being incorporated into clinical trials in health care. To systematically examine the design, reporting standards, risk of bias, and inclusivity of RCTs for medical machine learning interventions. In this systematic review, the Cochrane Library, Google Scholar, Ovid Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection online databases were searched and citation chasing was done to find relevant articles published from the inception of each database to October 15, 2021. Search terms for machine learning, clinical decision-making, and RCTs were used. Exclusion criteria included implementation of a non-RCT design, absence of original data, and evaluation of nonclinical interventions. Data were extracted from published articles. Trial characteristics, including primary intervention, demographics, adherence to the CONSORT-AI reporting guideline, and Cochrane risk of bias were analyzed. Literature search yielded 19 737 articles, of which 41 RCTs involved a median of 294 participants (range, 17-2488 participants). A total of 16 RCTS (39%) were published in 2021, 21 (51%) were conducted at single sites, and 15 (37%) involved endoscopy. No trials adhered to all CONSORT-AI standards. Common reasons for nonadherence were not assessing poor-quality or unavailable input data (38 trials [93%]), not analyzing performance errors (38 [93%]), and not including a statement regarding code or algorithm availability (37 [90%]). Overall risk of bias was high in 7 trials (17%). Of 11 trials (27%) that reported race and ethnicity data, the median proportion of participants from underrepresented minority groups was 21% (range, 0%-51%). This systematic review found that despite the large number of medical machine learning-based algorithms in development, few RCTs for these technologies have been conducted. Among published RCTs, there was high variability in adherence to reporting standards and risk of bias and a lack of participants from underrepresented minority groups. These findings merit attention and should be considered in future RCT design and reporting.

Anatomy in Action

Increasing and maintaining student engagement within anatomy education at a pre-collegiate level is a challenge that educators continue to encounter. Finding an appropriate level of difficulty that prepares students for the rigor of undergraduate anatomy education while balancing the need to inspire student interest in STEM-related fields of study can inadvertently discourage students, particularly when content is relayed in a ‘traditional’ lecture-based curriculum. The University of Colorado’s Pre-Health Scholars Program (CUPS) is an academic enrichment program for high school students from under-represented minority groups who are interested in healthcare and STEM-related professions. To address the challenges in pre-collegiate anatomy education, the CUPS anatomy curriculum has shifted away from instruction that is purely lecture-based, to a project-oriented curriculum utilizing 3D printing. Here, students are encouraged to connect hands-on experiences and collaborate on individualized projects that require mastery of anatomical principles to create. Students are also introduced to anatomic structures in a multi-dimensional fashion that allows them to examine the complimentary relationship between structure and function. This model of curriculum has the potential to improve engagement and create better foundations of anatomical knowledge through thoughtful instructional design.

Interventions to increase racial and ethnic minority accrual into cancer clinical trials: A systematic review.

Racial and ethnic minorities (REMs) continue to be underrepresented in clinical trials despite the 1993 National Institutes of Health's Revitalization Act mandating the representation of women and underrepresented minority groups in clinical trials. Although Blacks represent 15% and Hispanics 13% of the cancer population, their clinical trial enrollment rates are disproportionately low at 4% to 6% and 3% to 6%, respectively. A systematic review exploring interventions aimed at improving cancer clinical trial (CCT) enrollment for REMs was conducted. A systematic search of PubMed, Cochrane CENTRAL, and Ovid PsycINFO was conducted for English-language studies since 1993. Inclusion criteria included peer-reviewed, US-based studies with interventions aimed to recruit underrepresented minority adult patients into cancer clinical trials. REM groups were defined as Black, Hispanic, Asian, American Indian, and Native Hawaiian/other Pacific Islander. The systematic search identified 3123 studies, of which nine met inclusion criteria. Interventions included patient navigation/coaching (n= 4), a clinical trial educational video (n= 2), institutional research infrastructure changes (n= 1), a relationship building and social marketing recruitment model (n= 1), and cultural competency training for providers (n= 1). A statistically significant improvement in accrual was shown in three of the patient navigation interventions, one of the clinical trial educational videos and an institutional research infrastructure change. This systematic review illustrates several potential mechanisms by which to increase CCT recruitment for patients of REM backgrounds in various clinical settings. More randomized controlled trials are needed to further explore the benefits of these interventions for REMs.

Workforce Trends of Underrepresented Minority Nurses in the United States Over the Last Decade: Progress Towards Equal Representation?

A healthcare workforce representative of the race/ethnicity composition of the population it serves is central to addressing systemic health inequities. The aim of this study was to assess workforce trends of underrepresented minority (URM) nurses using the National Sample Survey of Registered Nurses years 2008 and 2018 and the American Community Survey years 2010 and 2019. We examined changes over time in URM composition (Black/African American (B/AA), Latine, American Indian/Alaskan Native (AI/AN), Native Hawaiian/Pacific Islander (NH/PI)) for registered nurses (RN), nurse practitioners (NPs), educational attainment (diploma/associate, BSN, MS(N)/PhD), job type (patient care, research, administration/supervision, teaching, other), and rural/urban location using descriptive statistics and bivariate regressions. While the proportion of the URM RN workforce grew significantly, the only URM group demonstrating proportional gains in the APRN workforce were Latine nurses. URM representation in educational attainment grew across all degree types. By 2018/2019, Latine nurses have their largest representation in the Dipl./ASN degree group and saw a proportional decline for PhD educated nurses. B/AA nurses have their largest representation at the MS(N)/PhD level. However, smaller proportions of B/AA nurses were working as APRNs compared to their non-URM colleagues. At the PhD level, few B/AA nurses were represented in research and teaching positions. A subgroup analysis of unemployed nurses seeking work revealed that B/AA and AI/AN nurses were overrepresented among unemployed nurses. While today's nursing workforce is more representative of the nation than ever before, results show unequal representation of URM and non-URM nurses across the ranks of the nursing professions that suggest unequal career and labor market opportunities.