White Group Research Articles

Exploring Microbes in Breast Tumors From Women of Different Races

Exploring Microbes in Breast Tumors From Women of Different Races

Black or African American patients undergo great saphenous vein ablation procedures for advanced venous disease and have the least improvement in their symptoms after these procedures

ObjectiveChronic venous insufficiency is an increasingly prevalent problem in the United States, with >25 million individuals currently affected. Previous work has shown that racial minorities and low socioeconomic status are associated with a worse clinical presentation and response to treatment. The present study aimed to determine the relationship between race, patient variables, hospital outcomes, and response to treatment for patients presenting for chronic venous insufficiency intervention. MethodsWe performed a retrospective analysis of all patients who underwent endovenous ablation (radiofrequency or laser) of the great saphenous vein to treat symptomatic, chronic venous insufficiency using Vascular Quality Initiative data from 2014 to 2020. Patient characteristics and outcomes were analyzed stratified by patient race. The χ2 test and the Kruskal-Wallis equality-of-populations rank test were used to measure the study outcomes. The primary outcomes were an improved venous clinical severity score and improvement in patient-reported outcomes. Patient characteristics, CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, prior venous interventions, length of stay, and time to follow-up were compared between races. ResultsThe database consisted of 9009 predominantly female patients (n = 6041; 67.1%), with a mean age distribution of 56 years. Of the 9009 patients, 7892 are White (87.6%), 627 Hispanic (6.9%), and 490 Black or African American (18.3%). The Hispanic cohort was younger than their White and Black/African American counterparts. Black/African American patients presented with more advanced clinical stages than did the White and Hispanic groups. The clinical stage according to race was as follows: C3—Black/African American, 32.9%; Hispanic, 38.9%; White, 46%; C5—Black/African American, 4.7%; Hispanic, 2.1%; White, 2.3%; and C6—Black/African American, 12.7%; Hispanic, 3.2%; White, 6.2%. Black/African American patients were more likely to present as overweight or obese (66%; P < .001) and less likely to be taking anticoagulation medication preoperatively (11%; P < .001). Non-White race was associated with a higher probability of treatment in the hospital setting (Black/African American, 63.6%; Hispanic, 87.5%; P < .001). Black/African American patients (3.25 ± 4.4; P < .001) demonstrated lower mean improvement postoperatively in both the venous clinical severity score and patient-reported outcomes than their White (4.25 ± 4.13, P <.001) and Hispanic (4.42 ± 3.78; P < .001) counterparts. ConclusionsDifferences exist in the clinical severity and symptom presentation based on race. Black/African American patients present with more advanced chronic venous insufficiency than do their White and Hispanic counterparts. Furthermore, the postprocedural analysis showed inferior clinical and self-reported improvement in chronic venous insufficiency for the Black/African American patients. Although the Hispanic population was younger, the White and Hispanic patients experienced similar responses to treatment.

Differential attainment in public health specialty training recruitment in the United Kingdom: an observational analysis of applicants from 2018 to 2020.

Differential attainment has been widely observed in United Kingdom (UK) medical training, with minority ethnicity being associated with reduced success in recruitment and progression through training. Specialty training in Public Health in the UK recruits candidates with medical as well as non-medical backgrounds. At the request of the UK Faculty of Public Health and Health Education England, we sought to examine whether differential attainment may or may not be occurring in the multi-stage recruitment process. We analysed 3years of national recruitment data into Public Health specialty training to identify whether demographic characteristics including age, sex, ethnicity and professional background were associated with successful recruitment. In total 2252 applications between 2018 and 2020 were analysed. Candidates who were older, Asian, black or from backgrounds other than medicine were significantly less likely to progress from the psychometric testing stage than the white British group. Fewer statistically significant differences were observed at the final stage of recruitment involving interviews, group work and a written task. The findings suggest that older candidates those from some ethnic minority backgrounds and those from backgrounds other than medicine are disadvantaged by the current recruitment process, with differential attainment associated with the psychometric testing stage.

Stress and resilience in British Indian parents with an autistic child: a comparative study with white British and Indian parents

PurposeThis study aims to examine the levels of stress and resilience in a sample of British Indian parents bringing up a child with autism.Design/methodology/approachA total of 52 British Indian parents took part in a survey that included measures of stress, resilience, support and child adaptive functioning. Results were compared to a sample of white British (n = 120) and Indian parents (n = 120).FindingsThe British Indian parents recorded higher levels of stress and less perceived social support than their white British counterparts. British Indian parents took longer to register concern about their child’s development and sought a diagnosis at a later age than the white British group. The delay in concern and diagnosis was similar to that found in the India group.Originality/valueThe research suggests that British Indian parents are disadvantaged in social support and mental well-being compared to white British parents and may face similar community pressures to parents bringing up a child in India.

The Effect of Chia Seeds on High-Density Lipoprotein (HDL) Cholesterol.

Chia seeds are touted as a healthy food capable of providing a beneficial effect on high-density lipoprotein (HDL) cholesterol. Similar claims have been made for oats in various forms, claiming that they improve cholesterol or are in some way "heart healthy." This study aims to demonstrate the effect of daily consumption of chia seeds, if any, on HDL cholesterol levels and compare this to the effects of oats on HDL levels. This pilot study is a randomized controlled trial performed at an academic primary care center. Participation was voluntary, and all participants provided written consent prior to enrollment. There were no exclusion criteria other than that participants must be adults and willing to come in to get their cholesterol profiles checked at the beginning and end of the study. The participants consumed their assigned breakfast in a standard serving size for a month with blood draws and weights recorded before and after the diet. The patients' cholesterol profiles were also compared with their weights. To standardize the delivery of chia seeds, the group consuming chia seeds mixed them with oatmeal. The three meal groups consisted of Cheerios (red group), oatmeal (white group), and oatmeal with chia seeds (blue group). Initially, there were a total of 11 subjects, three in the red group, four in the white group, and four in the blue group. Two subjects were lost to follow-up, one each from the red and white groups. Statistical analysis including one-way analysis was done with the means, Wilcoxon/Kruskal-Wallis, and one-way analysis tests. The results showed a similar weight gain pattern between the three groups, with an average of 2.8 lbs gained in the red group, 2.4 lbs gained in the white group, and 2.6 lbs gained in the blue group. The average HDL levels decreased by 1.00 mg/dL in the red group (standard deviation (SD) 2.82843), increased by 2.00 mg/dL in the white group (SD 8.88819), and increased by 5.75 mg/dL in the blue group (SD 8.01561). The HDL:total cholesterol ratios decreased by 0.00748 in the red group (SD 0.002660), an average of 0.04053 in the white group (SD 0.028138), and an average of 0.01614 in the blue group (SD 0.023808). The results suggest that both chia seeds and oatmeal may be good dietary sources to naturally increase HDL cholesterol, more substantially so with the diet including chia seeds, but may or may not improve total cholesterol:HDL ratios. The effect of weight gain is unclear, as all groups gained weight similarly. Hence, further study is warranted.

Geography, ethnicity, genealogy and inter‐generational social inequality in Great Britain

AbstractThis paper documents population‐wide inequalities of outcome in Great Britain amongst and between long‐established and more recently arrived family groups. ‘Establishment’ is defined using family group presence in the 1851 Census of Population as a benchmark, and the ethnicity or nationality of more recent migrants is determined through classification of given and family names. Inequalities of outcome are measured using a harmonised indicator of neighbourhood deprivation (hardship). White British individuals tend to live in the best neighbourhoods, but within‐group inequalities reflect regional locations in which different family names were first coined 700 or more years ago. The living circumstances of White Irish and Chinese migrants are observed to be in line with long‐established White British family lines, but other conventionally defined ethnic groups fare worse, some very markedly so. Disaggregation of conventional ethnic groups used by the Office for National Statistics such as White Other and Other Asian reveals stark within‐group inequalities. These findings suggest: (a) regional origins of inter‐generational inequalities amongst the White British; (b) comparable neighbourhood environments experienced by the White Irish, Chinese and some White Other groups and (c) significantly worse neighbourhood circumstances within and between other more recently arrived immigrant groups. This work has several implications for understanding economic assimilation of migrants and the existence of inequalities amongst and between populations.

Opioid and High-Risk Prescribing Among Racial and Ethnic Minority Veterans

The purpose of this study is to compare opioid prescribing and high-risk prescribing by race and ethnicity in a national cohort of U.S. veterans. A cross-sectional analysis of veteran characteristics and healthcare use was performed on electronic health record data for 2018 Veterans Health Administration users and enrollees in 2022. Overall, 14.8% received an opioid prescription. The adjusted odds of being prescribed an opioid were lower for all race/ethnicity groups than for non-Hispanic White veterans, except for non-Hispanic multiracial (AOR=1.03; 95% CI=0.999, 1.05) and non-Hispanic American Indian/Alaska Native (AOR=1.06; 95% CI=1.03, 1.09) veterans. The odds of any day of overlapping opioid prescriptions (i.e., opioid overlap) were lower for all race/ethnicity groups than for the non-Hispanic White group, except for the non-Hispanic American Indian/Alaska Native group (AOR=1.01; 95% CI=0.96, 1.07). Similarly, all race/ethnicity groups had lower odds of any day of daily dose >120 morphine milligram equivalents than the non-Hispanic White group, except for the non-Hispanic multiracial (AOR=0.96; 95% CI=0.87, 1.07) and non-Hispanic American Indian/Alaska Native (AOR=1.06; 95% CI=0.96, 1.17) groups. Non-Hispanic Asian veterans had the lowest odds for any day of opioid overlap (AOR=0.54; 95% CI=0.50, 0.57) and daily dose >120 morphine milligram equivalents (AOR=0.43; 95% CI=0.36, 0.52). For any day of opioid-benzodiazepine overlap, all races/ethnicities had lower odds than non-Hispanic White. Non-Hispanic Black/African American (AOR=0.71; 95% CI=0.70, 0.72) and non-Hispanic Asian (AOR=0.73; 95% CI=0.68, 0.77) veterans had the lowest odds of any day of opioid-benzodiazepine overlap. Non-Hispanic White and non-Hispanic American Indian/Alaska Native veterans had the greatest likelihood to receive an opioid prescription. When an opioid was prescribed, high-risk prescribing was more common in White and American Indian/Alaska Native veterans than in all other racial/ethnic groups. As the nation's largest integrated healthcare system, the Veterans Health Administration can develop and test interventions to achieve health equity for patients experiencing pain.

First and second trimester maternal serum markers for prenatal aneuploidy screening: An update on the adjustment factors for race, smoking, and insulin dependent diabetes mellitus

ObjectivesThe concentrations of maternal serum markers for aneuploidy screening are influenced by maternal characteristics such as race, smoking, insulin dependent diabetes mellitus (IDDM), and in vitro fertilization (IVF). Accurate risk estimation requires adjustment of initial values for these characteristics. This study aims to update and validate adjustment factors for race, smoking, and IDDM. MethodsThe study included singleton pregnancies that received multiple marker screening in Ontario, Canada between January 2012, and December 2018, and had their information collected in the Better Outcomes Registry & Network (BORN) Ontario. Serum markers assessed included first trimester pregnancy-associated plasma protein A (PAPP-A), free β and total human chorionic gonadotropin (hCG), placental growth factor (PlGF) and αlpha-fetoprotein (AFP); second trimester AFP, unconjugated estriol (uE3), total hCG and inhibin A. The Mann-Whitney U test was used to assess the differences in the median multiple of the median (MoM) of serum markers between study and reference groups. New adjustment factors were generated by dividing the median MoM of a particular race, individuals who smoke tobacco, or have IDDM by those of the reference groups. ResultsThe study included 624,789 pregnancies. There were statistically significant differences in serum marker concentrations among pregnant individuals who were Black, Asian, or First Nations compared to a White group, those who smoked compared to Non-smoking individuals, and those with IDDM compared to Non-IDDM group. New adjustment factors for race, smoking, and IDDM were validated by comparing median MoM of serum markers corrected using the current adjustment factors and new adjustment factors generated in this study. ConclusionThe adjustment factors generated in this study can adjust the effects of race, smoking, and IDDM on serum markers more accurately.

Association of serum uric acid with risk of stroke in US adults: A cross-sectional study from NHANES 1999–2020

Background and aimsThe validity of high uric acid levels as an independent cause of stroke remains controversial, and the association between its low concentration and stroke is unclear. This study determines how different serum uric acid (SUA) levels are associated with stroke risk. MethodsThis cross-sectional study used continuous National Health and Nutrition Examination Survey data in the United States during 1999–2020. The SUA levels of 6.0, 6.8, and 9.0 mg/dL were all considered as cut-off points. Restricted cubic spline interpolation and logistic regression models were used to evaluate the different associations. Subgroup analyses and sensitivity analyses were conducted to evaluate the influence of multiple factors on the outcomes. ResultsThe study included 23,413 participants aged ≥ 20 years. A J-shaped curve existed between SUA and stroke risk, and the risk of stroke was positively correlated with SUA levels in the overall population. Subgroup analysis of all adults in the SUA 6.8–9.0 mg/dL group showed that stroke risk for non-Hispanic white, obese, ex-smoker, and heavy drinking groups was increased, but for the other Hispanic group was reduced. In the SUA < 6.0 mg/dL group, stroke risk for ex-smoker, heavy drinkers, and no chronic kidney disease groups was increased. ConclusionOur findings indicate a J-shaped relationship between SUA levels and stroke risk. Low and high SUA levels increased stroke risk for different populations, except in the other Hispanic population. Early SUA management is highly significant for stroke prevention in high-risk populations.

Adverse Childhood Experiences, Household Income, and Mentorship Among Interns Who Are Underrepresented in Medicine.

Underrepresented in medicine (UIM) interns have unique lived experiences that affect their paths to medicine, and more information is needed for medical residency and fellowship programs to better support them. We describe self-reported differences between UIM and White physician interns in key demographic areas, including household income growing up, physician mentorship, and adverse childhood experiences (ACEs). Between 2019 and 2021, we administered a diversity survey to incoming medical interns at the University of Minnesota-Twin Cities. Response rates across the 3 years were 51.2% (167 of 326), 93.9% (310 of 330), and 98.9% (354 of 358), respectively. We conducted analyses to compare UIM and White groups across demographic variables of interest. A total of 831 of 1014 interns (81.9%) completed the survey. Relative to White interns, UIM interns had lower household incomes growing up, lower rates of mentorship, and higher rates of experiencing 4 or more ACEs. The odds of experiencing the cumulative burden of having a childhood household income of $29,999 or less, no physician mentor, and 4 or more ACEs was approximately 10 times higher among UIM (6.41%) than White (0.66%) interns (OR=10.38, 95% CI 1.97-54.55). Childhood household income, prior mentorship experiences, and number of ACEs differed between UIM and White interns.

Cardiorespiratory fitness is an important marker of cognitive performance in older Latin Americans

AbstractBackgroundOur previous research with older non‐Hispanic whites demonstrated that with increasing cardiorespiratory fitness (CRF) there was a concomitant linear increase in processing speed (PS) performance. PS has also been found in a number of reports as a potential precursor to memory decline associated with Alzheimer’s disease and cognitive aging. The purpose of this study was to examine whether the same cognitive benefits imbued by CRF generalize within a healthy Latino aging community living in Costa Rica (CR).Method415 community dwelling older adults (315 CR and 100 non‐Hispanic whites living in the United States) with a mean age of 71 (SD = 5.29) years old were recruited from the Epidemiology and Development of Alzheimer’s Disease (EDAD), a large international study of Latino cognitive aging. Participants completed neuropsychological testing and a graded treadmill exercise stress test. We compared the relationship between Oxygen Uptake Efficiency Slope (OUES) and a composite measure of PS (Digit Symbol, Block Design, and Stroop Color Naming). Confirmatory factor analysis was conducted.ResultCRF (OUES) significantly predicted PS within the CR (B = 0.50; p &lt; .001) group and non‐Hispanic white (B = 0.25; p &lt; .05) group after controlling for age and sex. The relationship between CRF and the PS factor showed a non‐significant misfit when the relationship was constrained to be equal on both groups (χ² (1) = 0.39, p = 0.53), hence the relationship is equivalent between groups.ConclusionIn a healthy sample of older individuals living in CR we found the same score profile and interrelationships that were identified among non‐Hispanic whites living in the United States. CRF and PS are clinically meaningful therapeutic targets for dementia prevention among older Latin Americans.

Modality matters for health disparity groups on the Montreal Cognitive Assessment (MoCA): Findings from the Einstein Aging Study (EAS)

AbstractBackgroundThe Telephone‐Montreal Cognitive Assessment (T‐MoCA) is a widely‐used, remotely administered cognitive screen. The T‐MoCA demonstrates adequate psychometric properties and may be used when standard, in‐person administration of the MoCA is not feasible (Katz et al., 2020). There is a critical need to investigate the agreement of the T‐MoCA across administration modalities (in‐person versus telehealth) among ethnically and racially diverse populations.MethodsThe Einstein Aging Study (EAS) includes a community‐based of racially/ethnically diverse community‐dwelling individuals, ≥ age 70 from the Bronx, NY. Participants (N = 424) were free of dementia at enrollment and completed the T‐MoCA along with in‐person neuropsychological tests including the MoCA‐22, which excludes items unsuitable for telephone administration paralleling the T‐MoCA (Table 1). Intraclass correlation coefficients (ICCs) between T‐MoCA and MoCA‐22 were used to measure agreement. Linear mixed effects models were applied to compare mean scores and ICCs among ethnic/racial groups, with and without adjusting for age, gender, education and depressive symptoms.ResultsParticipants were on average 78.2 years, 65.8% female, 47.6% non‐Hispanic White, 38.0% non‐Hispanic Black, and 14.4% Hispanic. There was no significant difference between mean T‐MoCA and MoCA‐22 scores and no differential associations with age, gender, education, and depressive symptoms. For both modalities, NH Black (difference ‐1.54, p&lt;.0001) and Hispanic (difference ‐2.04, p&lt;.0001) groups demonstrated significantly lower scores compared to non‐Hispanic Whites (Table 2). As shown in Table 2, ICCs among non‐Hispanic White, non‐Hispanic Black, and Hispanic groups were 0.64, 0.50 and 0.42, respectively, and comparisons of ICCs to non‐Hispanic White were significantly lower in non‐Hispanic Black (p = 0.0495) and borderline significant in Hispanic participants (p = 0.0552). Findings were similar after adjusting for covariates.ConclusionThe agreement between telephone and in‐person modalities of the MoCA was weaker in non‐Hispanic Black and Hispanic participants (compared to non‐Hispanic White). Further investigation of factors and/or items that contribute to these lower correlations is warranted. Although the T‐MoCA and other remotely administered cognitive screens have the potential to broaden accessibility to marginalized groups, researchers must use caution when developing or selecting appropriate demographically adjusted norms and interpreting scores of diverse older adults.

Tracking ongoing transboundary marine distributional range shifts in the digital era

The digitalization of society is providing new opportunities to track spatio-temporal redistribution of species across national boundaries in near real-time. This is particularly interesting for marine species for which dynamics are difficult to monitor. We took advantage of the ongoing northward distributional range shift of the white grouper Epinephelus aeneus in Italy, Spain and France (Mediterranean Sea) to test the performance and complementarity of 4 emerging digital methods: (1) local ecological knowledge of recreational fishers actively collected using social media; (2) passive data mining of recreational fishing on social media; (3) Wikipedia page views; and (4) Google search volumes. We compared the temporal changes in maximum latitude of occurrence of the species from local ecological knowledge, passive data mining and traditional scientific knowledge and matched it with the thermal habitat of the species. Moreover, we compared the Wikipedia page views and Google search volumes to assess whether societal interest has a relationship with the distributional range shift of the species. Local ecological knowledge and passive data mining on social media complement traditional scientific knowledge, but are more sensitive as suggested by their significant relationship with the thermal habitat of the species. Wikipedia page views and Google search volumes were higher in Italy where the species is more common, but temporal trends within countries did not agree with changes in the distribution, and likely reflect local societal interest. Digital methodologies can complement traditional scientific knowledge with limited associated costs and with the additional ability to provide social insights for species on the move.

0107 Rest-activity rhythmicity across the lifespan: findings from the National Health and Nutrition Examination Survey (NHANES)

Abstract Introduction Non-parametric metrics of interdaily stability (IS), relative amplitude (RA), and intradaily variability (IV) characterize between- and within-day rest-activity rhythms. Prior research has reported differences in these metrics by age and race/ethnicity, but these differences have not been widely assessed in children and adolescents. Therefore, we investigated associations of these metrics with sociodemographic factors across the lifespan, including children, in a US-representative cross-sectional study. Methods Rest-activity metrics were derived from actigraphy data (wrist-worn GT3X+ ActiGraph devices) measured over one week in the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Pregnant participants and participants with &amp;lt; 4 days of valid data were excluded; missing activity data were imputed and pooled using Rubin’s rule. Population-weighted linear and ordinal logistic regression (quartiles) models were fit to examine the associations of age, gender, smoking, body mass index (BMI), income-to-poverty ratio, and self-reported race/ethnicity with rhythmicity measures. Stratified analyses by age groups were conducted. Results There were n=12,526 participants aged 3-80 years. In adjusted analyses, IS and RA (higher: stronger rhythms) decreased with age and were lower among men, whereas IV (higher: weaker rhythm, greater fragmentation) increased with age (p&amp;lt; 0.05). Higher income-to-poverty ratio associated with higher RA (1-unit OR=1.11, 95%CI:1.06,1.16) and IV (1-unit OR=1.10, 95%CI:1.07,1.13). Greater BMI associated with lower RA and IS and higher IV (p&amp;lt; 0.05). Smoking associated with decreased values for all metrics. Compared to the non-Hispanic White group, the Asian, non-Hispanic Black, and Other/Multiracial groups were more likely to have lower RA, lower IS, and higher IV (p&amp;lt; 0.05). Compared to the non-Hispanic White group, the Mexican American (OR=0.83, 95%CI:0.72,0.95) and Other Hispanic (OR=0.83, 95%CI:0.73,0.94) groups were less likely to have higher IV. Analyses stratified by age (≤18, &amp;gt;18 years) resulted in similar patterns among the Asian, non-Hispanic Black, and Other/Multiracial groups (p&amp;lt; 0.05). Conclusion Rest-activity rhythms differ by age, gender, BMI, income, smoking, and race/ethnicity, representing possible windows for public health intervention and sleep health promotion. Differences in rest-activity measures by race/ethnicity begin in childhood, are evident in early adolescence, and persist throughout adulthood. Future analyses will evaluate the contribution of environmental factors to these differences. Support (if any) NIH-NHLBI T32HL007901, R35HL135818

The Role of Government Politics and Law in Building Public Participation in Elections

The use of voting rights in a general election is the subjective right of citizens (people) who have qualified to vote, but from the aspect of the interests of the state and nation, it can be considered that the use of voting rights / voting rights of citizens in general elections, in essence is a form of responsibility to participate in the administration of government. However, at the current level of reality there is a tendency for people to experience "frustration" and "political lethargy" to exercise their sovereignty through the mechanism of elections. This fact is due to the fact that people feel that their aspirations cannot be accommodated after the general election and presidential election. In addition, there is the influence of pressure groups (especially groups that want the disintegration of the nation and the Unitary State of the Republic of Indonesia) so that people better abstain and become "white groups". Therefore, a directed and effective government legal policy is needed to increase legal awareness of citizens participating in exercising their active voting rights in general elections and presidential elections.&#x0D;

Social determinants of health and premature death among adults in the USA from 1999 to 2018: a national cohort study

Racial and ethnic disparities in mortality persist in the US population. We studied the contribution of social determinants of health (SDoH) to racial and ethnic disparities in premature death. A nationally representative sample of individuals aged 20-74 years who participated in the US National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 were included. Self-reported SDoH (employment, family income, food security, education, access to health care, health insurance, housing instability, and being married or living with a partner) were collected in each survey cycle. Participants were categorised into four groups of race and ethnicity: Black, Hispanic, White, and other. Deaths were ascertained from linkage to the National Death Index with follow-up until 2019. Multiple mediation analysis was used to assess simultaneous contributions of each individual SDoH to racial disparities in premature all-cause mortality. We included 48 170 NHANES participants in our analyses, consisting of 10 543 (21·9%) Black participants, 13 211 (27·4%) Hispanic participants, 19 629 (40·7%) White participants, and 4787 (9·9%) participants of other racial and ethnic groups. Mean survey-weighted age was 44·3 years (95% CI 44·0-44·6), 51·3% (50·9-51·8) of participants were women, and 48·7% (48·2-49·1) were men. 3194 deaths before age 75 years were recorded (930 Black participants, 662 Hispanic participants, 1453 White participants, and 149 other participants). Black adults had significantly higher premature mortality than other racial and ethnic groups (p<0·0001): premature death rates per 100 000 person-years were 852 (95% CI 727-1000) for Black adults, 445 (349-574) for Hispanic adults, 546 (474-630) for White adults, and 521 (336-821) for other adults. Unemployment, lower family income, food insecurity, less than high school education, no private health insurance, and not being married nor living with a partner were significantly and independently associated with premature death. Dose-response associations were observed between cumulative number of unfavourable SDoH and premature all-cause mortality: hazard ratios (HRs) were 1·93 (95% CI 1·61-2·31) for those with one unfavourable SDoH, 2·24 (1·87-2·68) for those with two, 3·98 (3·34-4·73) for those with three, 4·78 (3·98-5·74) for those with four, 6·08 (5·06-7·31) for those with five, and 7·82 (6·60-9·26) for those with six or more unfavourable SDoH (p<0·0001 for linear trend). After adjusting for SDoH, HRs for premature all-cause mortality for Black adults compared with White adults decreased from 1·59 (1·44-1·76) to 1·00 (0·91-1·10), suggesting complete mediation of this racial difference in mortality. Unfavourable SDoH are associated with increased rates of premature death and contribute to differences between Black and White racial groups in premature all-cause mortality in the US population. Innovative public health policies and interventions targeting SDoH are needed to reduce premature deaths and health disparities in this population. US National Institutes of Health.

Social determinants of racial health inequities

Social determinants of racial health inequities

Racial differences in atrial fibrillation-related bleeding and mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background Adverse outcomes associated with atrial fibrillation (AF) in Asians have not yet been fully elucidated. This study was designed to study racial differences in the risk for bleeding and the effect of new-onset AF on bleeding and mortality. Methods This study is based on a patient-level comparative analysis of UK Biobank and Korean National Health Insurance Service-Health Screening data. The primary outcome was intracranial hemorrhage (ICH). The secondary outcomes were major bleeding and gastrointestinal (GI) bleeding. Five-year incidence rates (IR), rate difference (IR in those with AF minus IR in those without AF) and rate ratio (IR in those with AF divided by IR in those without AF) of the outcomes were calculated. Results Between 2005 and 2012, we identified 422,121 Asians (mean [SD] age, 55.1 [8.4] years; 54.2% of men) and 380,763 Whites (mean [SD] age, 57.1 [8.0] years; 45.1% of men). During the five-year follow-up period, the IR of AF per 1000 person-years were 2.29 (95% CI, 2.22–2.35) in Asians and 3.55 (95% CI, 3.46–3.63) in Whites. The IR of ICH was greater in Asians with and without AF than in corresponding White groups. The rate difference for ICH was 1.84 (95% CI, 1.18–2.51) in Asians and 0.80 (95% CI, 0.56–1.04) in Whites. For major bleeding, the IR of Asians were not only higher than those of Whites, but also the rate difference was 1.3-fold higher in Asians than in Whites. However, different tendencies were observed for GI bleeding. Conclusion Despite the higher incidence of AF in Whites, Asians with AF have a worse prognosis in terms of ICH and major bleeding. However, further studies are needed to explain the different trends of gastrointestinal bleeding.

Stricter blood pressure control reduces rate of left ventricular hypertrophy and diastolic dysfunction in ethnic minority groups in the UK:E-ECHOES study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation (PG/05/036) Primary Care Research Network-Central England. Background Blood pressure (BP, mmHg) targets have been mainly determined based on the white ethnic group. Optimal BP levels have been less established in people of South Asian and African Caribbean origin. There is less data on how different office BP values influence the presence of cardiac target organ damage, left ventricular hypertrophy (LVH) and diastolic dysfunction (DD). Methods This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, South Asian and African-Caribbean origin, age ≥45 years). Echocardiography was used to diagnose LVH and DD following British Echocardiographic Society criteria. Optimal receiver operator curves (ROC) cut-off values for predicting LVH and DD were determined using the Leu method. Multivariable logistic regression, adjusted for age and sex, was used to determine the effects of different BP values for LVH and DD, using SBP 130-&amp;lt;140 and DBP 80-&amp;lt;90 as comparators (STATA 13). Results The study included 3200 South Asians (age 59±10, 52% women), of whom 1568 (49%) had LVH, and 1497 (47%) had diastolic dysfunction. Of people with LVH, 869 (55%) had SBP &amp;gt;140, and 372 (24%) had DBP &amp;gt;90. The optimal BP cut-off for ROC analysis was 139/80.5 for LVH and 139/80.5 for diastolic dysfunction. SBP &amp;lt;130 and DBP &amp;lt;80 were both associated with a 31% reduction in diastolic dysfunction (Table). BP ≥140/90 was strongly predictive of LVH and DD. The study included 1922 African Caribbeans (62±12 age, 55% women), of whom 1186 (62%) had LVH and 1124 (58%) had DD. Of people with LVH, 778 (66%) had SBP &amp;gt;140, and 333 (28%) had DBP &amp;gt;90. The optimal BP cut-off for ROC analysis were 139/81.5 for LVH and 138/80.5 for DD. DBP &amp;lt;80 mmHg 27% reduction in LVH and 24% in DD (Table). BP ≥140/90 was strongly predictive of LVH and DD. Conclusions People of South Asian origin may benefit from stricter SBP (&amp;lt;130) control, and both ethnic groups may benefit from stricter DBP (&amp;lt;80) control.

La colonialidad del Espíritu Santo en el pentecostalismo brasileño

This dossier aims to point out the coloniality of Holy Spirit, an integral person of the Divine Trinity, in current Brazilian Pentecostalism, in favor of whiteness in the sphere of power. The research points out that there is a process of invisibilization and erasure that does not allow the rise of black religious agents in Pentecostal communities, even though these religious communities are mostly formed by black people and located in the peripheries. The text seeks to reflect on the theme going through the roots of the foundation of Brazilian Pentecostalism and reaching the present day. We observe similarities with colonial Catholicism when the groups that hold power in Pentecostalism begin to use practices that privilege a white elite group. In this sense, we present broader aspects, addressing different points of view and possibilities to understand the different approaches to the coloniality of Holy Spirit in Brazilian Pentecostalism. Here, we work with the perspective of the Brazilian religious matrix absorbed by the Pentecostal movement and, furthermore, we work on aspects of the existing power frontiers between pastors from the peripheries against the superiority of pastors who are presidents of the Assemblies of God.