non-Latino Whites Research Articles

Neighborhood disadvantage and dementia incidence in a cohort of Asian American and non-Latino White older adults in Northern California.

Some evidence suggests that neighborhood socioeconomic disadvantage is associated with dementia-related outcomes. However, prior research is predominantly among non-Latino Whites. We evaluated the association between neighborhood disadvantage (Area Deprivation Index [ADI]) and dementia incidence in Asian American (n = 18,103) and non-Latino White (n = 149,385) members of a Northern California integrated health care delivery system aged 60 to 89 at baseline. Race/ethnicity-specific Cox proportional hazards models adjusted for individual-level age, sex, socioeconomic measures, and block group population density estimated hazard ratios (HRs) for dementia. Among non-Latino Whites, ADI was associated with dementia incidence (most vs. least disadvantaged ADI quintile HR = 1.09, 95% confidence interval [CI] = 1.02-1.15). Among Asian Americans, associations were close to null (e.g., most vs. least disadvantaged ADI quintile HR = 1.01, 95% CI = 0.85-1.21). ADI was associated with dementia incidence among non-Latino Whites but not Asian Americans. Understanding the potentially different mechanisms driving dementia incidence in these groups could inform dementia prevention efforts.

Trajectories of cognitive functioning in later life: Disparities by race/ethnicity, educational attainment, sex, and multimorbidity combinations

Evaluating multimorbidity combinations, racial/ethnic background, educational attainment, and sex associations with age-related cognitive changes is critical to clarifying the health, sociodemographic, and socioeconomic mechanisms associated with cognitive function in later life. Data from the 2011–2018 National Health and Aging Trends Study for respondents aged 65 years and older (N = 10,548, mean age = 77.5) were analyzed using linear mixed effect models. Racial/ethnic differences (mutually-exclusive groups: non-Latino White, non-Latino Black, and Latino) in cognitive trajectories and significant interactions with sex and education (<high school, high school, some college, and ≥ college degree) were evaluated. Models included sex, education, ever covered by Medicaid, coupled status, waist-height ratio, study cohort, and chronic disease category (no diseases; one disease; advanced cardiovascular multimorbidity; metabolic multimorbidity; advanced cardiovascular-metabolic multimorbidity; and neither advanced cardiovascular nor metabolic multimorbidity). In covariate-adjusted models, Black (b = −1.31, 95% CI: 1.74,-0.89) and Latino (b = −0.83, 95% CI: 1.58,-0.07) respondents had lower cognitive scores at age 65 and steeper declines with age (b = −0.08, 95% CI: −0.15,-0.01; b = −0.20, 95% CI: 0.34,-0.05, respectively) compared with White respondents. Cognitive scores were lower among respondents with advanced cardiovascular (b = −0.28, 95% CI: 0.54,-0.01) and advanced cardiovascular-metabolic (b = −0.56, 95% CI: 0.86,-0.27) multimorbidity compared with respondents with none of the chronic diseases of interest. In interaction models, protective associations by female sex and higher education were not observed among minority racial/ethnic groups. It is important to develop interventions to postpone cognitive decline among older Black and Latino adults.

Disparities in HbA1c testing between aging US Latino and non-Latino white primary care patients

US Latinos disproportionately face diabetes-related disparities compared to non-Latino Whites. A number of barriers, including linguistic and cultural discordance, have been consistently linked to these disparities. Glycated hemoglobin (HbA1c) testing is used to assess glycemic control among individuals living with diabetes. This study aimed to compare HbA1c levels and corresponding testing rates among non-Latino Whites and Latinos with both English and Spanish preference from a national cohort of primary care patients within community health centers.We analyzed electronic health records from patients who turned 50 years of age (n = 66,921) and were diagnosed with diabetes during or prior to the study period. They also must have been under observation for at least one year from January 1, 2013 to December 31, 2017. We calculated the rates of HbA1c tests each person received over the number of years observed and used covariate-adjusted negative binomial regression to estimate incidence rate ratios for Spanish preferring Latinos and English preferring Latinos compared to non-Latino Whites. Spanish preferring Latinos (rate ratio = 1.23, 95% CI = 1.16–1.30), regardless of HbA1c level, had higher testing rates than non-Latino Whites and English preferring Latinos. English preferring Latinos with controlled HbA1c levels had higher rates of HbA1c testing compared to non-Latino whites.Overall, the Latinos with Spanish preference maintained higher HbA1c testing rates and had disproportionately higher rates of uncontrolled HbA1c levels compared to non-Latino whites. Future efforts should focus on understanding effective approaches to increasing engagement among Spanish preferring Latinos and addressing organizational-level barriers, given HbA1c disparities.

Race/Ethnic Differences, Skin Tone, and Memory Among Older Latinos in the United States.

U.S. Latino populations are diverse. Research on racial identity, skin tone, and Latino health is imperative for understanding and combating racism and colorism. We examined differences in memory performance: among non-Latinos and Latinos who identified as Black, other, and White in the United States and then among Puerto Ricans in Boston whose skin tones ranged from dark, medium, light to "white." We used 2010 Health and Retirement Study and 2004 Boston Puerto Rican Health Survey data, respectively, to examine racial and color differences in memory performance among 50 and older adults in the United States and Puerto Rican older adults in Boston. We applied ordinary least squares regression to immediate and delayed word recall test scores and adjusted for education, health conditions, and health behaviors. In adjusted models, White non-Latinos had better memory performance than White Latinos. Black Latinos, other Latinos, and Black non-Latinos had lower delayed word recall scores than White Latinos. Black Latinos and Black non-Latinos had similar scores. Intra-Latino racial disparities endured despite the inclusion of education and other covariates. Among Puerto Ricans in Boston, medium-toned individuals had higher scores than "white"-toned individuals. Findings support the importance of examining self-identified race and skin tone in Latino aging research. Further investigation is needed to understand the stubborn intra-Latino racial disparities in memory performance and surprising adverse cognitive performance among "white"-toned relative to darker-toned Puerto Ricans in Boston.

Abstract EP20: Immigrant-related Factors And Prediabetes Prevalence Among Latinos In The Us

Background: Latinos have a nearly two-fold increased risk of diabetes and diabetes-specific mortality compared to non-Latino whites. Until recently, foreign-born individuals have shown a lower prevalence of diabetes. However, limited research has examined the social and demographic factors contributing to prediabetes among Latinos. Directing prevention efforts towards those classified at the prediabetes stage presents a critical window of opportunity to prevent the transition to diabetes and subsequent morbidity and mortality. We characterized prediabetes prevalence across social, demographic, and immigrant factors in a nationally representative sample of Latino adults living in the United States (US). Hypothesis: Foreign-born Latinos will have a higher prevalence of prediabetes than US-born for select characteristics. Methods: Our study population included Latino adults 20+ years of age sampled in the National Health and Nutrition Examination Survey (NHANES), 2013-2018 (n=4,060). We examined prediabetes prevalence measured via A1C levels of 5.7-6.4 by age, sex at birth, nativity, occupational status, and poverty threshold accounting for the complex sampling design of NHANES. We also tested if nativity modified these social and demographic risk factors. Results: A total of 8,237,647 million Latinos met the criteria for prediabetes, resulting in an estimated prevalence of 27.9%. We found an increasing trend for prediabetes for greater time residing in the US (22%, 26%, and 40% for &lt;10 years, 10-19 years, and &gt;20 years, respectively). Moreover, across most social and demographic characteristics, foreign-born Latinos had a higher prevalence of prediabetes than US-born Latinos. Conclusion: Our findings suggest clear patterns of increased prediabetes prevalence among foreign-born Latinos relative to their US-born counterparts. Future diabetes prevention efforts are needed to address the higher prediabetes burden among the foreign-born and design tailored interventions for this group that address structural as well as cultural factors patterning these disparities.

Diminished Effects of Educational Attainment on Time Spent on Substance/Drug Use in Latino Individuals: Analysis of the American Time Use Survey (ATUS)

Background: While socioeconomic status (SES) indicators such as educational attainment are among the major drivers of health behaviors such as substance use, the protective effects of these indicators may differ across ethnic groups. Built on the Marginalization related Diminished Returns (MDRs) phenomenon that refers to weaker health effects of SES indicators for marginalized and minoritized groups (vs. non-Latino White people), we conducted this study with two aims: First to test the association between educational attainment and time spent on substance/drug use, and second, to test for ethnic variation in this association. Methods: This cross-sectional study used the American Time Use Survey (ATUS 2019) data. Participants included 7380 individuals who were either Latino or non-Latino White. We tested for associations between time spent on substance/drug use and a continuous measure of educational attainment using linear regression. Age and sex were control variables. We used logistic regression for sensitivity analysis using any time spent on substance/drug as the outcome. Results: Overall, high educational attainment showed an inverse association with time spent on substance/drug use overall. We also documented a statistical interaction between ethnicity and educational attainment such that associations between educational attainment and time spent on substance/drug use was weaker in Latino vs. non-Latino White individuals. We could replicate the results using logistic regression for any time spent on substance/drug as the outcome. Conclusion: We observe that SES indicators such as educational attainment may have a differential protective effect against time spent on substance/drug use for diverse ethnic groups. In contrast to non-Latino White individuals, Latino individuals reported spending similar amounts of time on substance/drug use across the full SES spectrum. This finding is in line with the MDRs framework and may be attributable to the effects of structural racism, social stratification, and marginalization impacting ethnic minorities in the United States.

Age Differences in Clinical Trial Understanding in Non-Hodgkin Lymphoma Patients

BackgroundClinical trials are often an important component of cancer care but are misunderstood by many patients. Few studies have examined age differences in clinical trial understanding in older versus younger adults, especially among patients with indolent non-Hodgkin lymphoma (NHL), a slowly progressive and not typically curable cancer diagnosed primarily in older adults. Patients and MethodsParticipants aged ≥21 years with a diagnosis of NHL were recruited from a single academic medical center in an urban setting. Age was dichotomized as <65 and ≥65 years. Clinical trial understanding was assessed using a four-item survey of potential goals of a clinical trial, with responses including “yes,” “no,” and “I don't know.” Survey responses were examined by age using Chi-square tests. ResultsThe sample was comprised of 74 patients who were predominantly non-Latino White, with a mean age of 60.4 years (SD = 12.27). Compared to younger patients, older patients were more likely to respond “I don't know” to the clinical trial goals of reducing the lymphoma (41.4% vs. 13.3%; P = .023) and keeping the lymphoma from worsening (41.4% vs. 13.3%; P = .017). Age differences for the remaining goals were not statistically significant. Similar findings emerged when the sample was restricted to patients under active surveillance. ConclusionRelative to younger adults, older adults may have a less nuanced understanding of clinical trial goals. Therefore, older adults may benefit from developmentally-tailored interventions to improve clinical trial understanding. Future research should examine the relationship between clinical trial understanding and enrollment by age using validated measures in diverse samples.

Community Violence Exposure and Stress Reactivity in African American and Non-Latino White Adolescents With Overweight/Obesity.

Adolescents who experience community violence are exposed to toxic stressors at a critical period of growth and development. The purpose of this study was to examine the relationship between community violence exposure and stress reactivity in African American and non-Latino white adolescents with overweight/obesity. Fifty-one adolescents (47% female, 55% African American; aged 14-19) participated in this study. Community violence was assessed using the Survey of Children's Exposure to Community Violence. Stress reactivity was assessed via salivary cortisol and alpha-amylase area under the curve (AUC) during a Trier Social Stress Test (TSST). Race was a significant predictor of alpha-amylase reactivity (β = 10740±3665, p = 0.0006), with a higher alpha-amylase AUC observed in African American compared to non-Latino white adolescents. There was also a significant difference in the relationship between community violence exposure and alpha-amylase AUC by race (β = -3561±1226, p = 0.007). At similar increases in violence exposure, African Americans demonstrated a significant decline in alpha-amylase AUC while non-Latino whites demonstrated a significant increase in alpha-amylase AUC. Neither race nor violence exposure were significant predictors of cortisol AUC and there were no significant differences in the relationship between community violence exposure and cortisol AUC by race (all p's > .05). These preliminary findings suggest exposure to community violence may act to exacerbate autonomic dysregulation in African American adolescents with overweight/obesity. Longitudinal studies are needed to confirm the mechanisms by which community violence exposure differentially impacts stress responses by race.

Latino CRS Patients Have Comparable Outcomes to White Patients Before and After Treatment of CRS

To our knowledge there are no prior studies evaluating the role of Latino ethnicity in the outcomes of CRS. Our study aimed to understand whether Latino patients have different histopathology/outcomes of CRS compared to non-Latino whites.

Factors Associated With Receipt of Smoking Cessation Advice and Assistance by Health Professionals Among Latino and Non-Latino White Smokers With Medicaid Insurance in California

Nationally, Latino smokers are less likely than non-Latino White smokers to receive advice and assistance from health professionals to quit smoking. California's Medicaid expansion included the Patient Protection and Affordable Care Act's comprehensive tobacco cessation benefits; however, it is unknown whether expanded coverage helped resolve this disparity. To examine the association between race and ethnicity (Latino and non-Latino White) and health professional cessation advice and assistance among smokers with Medi-Cal insurance in the post-Affordable Care Act period. This repeated cross-sectional study was conducted with the 2014 and 2016-2018 California Health Interview Survey. A total of 1861 Latino and non-Latino White current smokers aged 18 to 64 years who had Medi-Cal insurance and consulted a health professional in the past 12 months were included. Data were analyzed between December 1, 2019, and April 30, 2021. Race and ethnicity classified as Latino or non-Latino White. The outcomes were receipt of health professional advice to quit smoking or assistance to quit in the past 12 months. Logistic regression was used to examine the association between race and ethnicity and each outcome, adjusted for sociodemographic factors, smoking behavior, health care factors, and acculturation measures. All estimates were weighted to adjust for the complex survey design. Among 1861 participants, 44.8% were Latino, 53.8% were aged 40 years or older (mean [SE], 39.7 [0.79] years), 54.1% were male, and 59.9% had less than a high school education. Latino smokers were less likely than non-Latino White smokers to receive health professional advice (38.3% Latino smokers vs 55.3% non-Latino White smokers) or assistance (21.8% Latino smokers vs 35.7% non-Latino White smokers). In the unadjusted model, compared with non-Latino White smokers, Latino smokers were less likely to receive advice (odds ratio [OR], 0.50; 95% CI, 0.29-0.86) and also less likely to receive assistance (OR, 0.50; 95% CI, 0.25-1.00). However, in the adjusted model, race was no longer significant. Smokers with more office visits (adjusted OR, 2.44; 95% CI, 1.61-3.70) and those with at least 1 chronic disease (adjusted OR, 1.99; 95% CI, 1.15-3.43) were more likely to receive advice from a health professional. Additionally, daily smokers compared with nondaily smokers (adjusted OR, 2.29; 95% CI, 1.03-5.13) were more likely to receive assistance. In this cross-sectional study, more office visits, having a chronic disease, and daily smoking were associated with an increased likelihood of receiving smoking cessation advice or assistance. Use of strategies to engage tobacco users outside of the clinic, such as proactive outreach and community-based engagement, may help address this disparity.

The Effect of Donor-Recipient Race and Ethnicity Match on Liver Transplantation Outcome in The United States

Introduction: Recipient race/ethnicity (R/E) affect liver transplantation (LT) outcomes. However, the effect of donor R/E or donor-recipient R/E match is not well studied. We aimed to describe the impact of different donor and recipient R/E match on post-LT survival in the United States. Methods: We performed a retrospective study using the Scientific Registry of Transplant Recipient (SRTR) database. Donors and recipients are categorized into five R/E groups: Asian, Black, Latino, non-Latino White, and Others. We used Kaplan-Meier and Cox Proportional Hazards models for statistical analyses, adjusted for donor and recipient covariates. Results: 85,427 LT recipients between 2002 and 2019 were included in this study. Compared to non-Latino white donors or recipients, Asian and Black recipients had the lowest and highest risk of post LT mortality, respectively. Additionally, multivariate-adjusted models demonstrated that receiving Asian donor liver is associated with worse survival in all recipients besides Asians. Furthermore, the mortality risk for Black recipients normalized only when receiving livers from Black donors. However, this advantage of exact R/E matching is not distinctly evident in other R/E groups. Lastly, the effect size of donor and recipient R/E on post-LT survival is comparable to, if not higher than, many other known risk factors such as BMI, receiving cardiac death donor grafts, etc., suggesting unknown sources of variance. Conclusion: Donor and recipient R/E has significant associations with post-LT overall survival. Further studies must identify the uncharacterized social determinants of health and biologic factors with particular attention to addressing systemic racism within practice of LT.

PD47-04 NATIVITY AND BLADDER CANCER OUTCOMES IN MULTI-ETHNIC POPULATIONS: A CALIFORNIA CANCER REGISTRY ANALYSIS

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II (PD47)1 Sep 2021PD47-04 NATIVITY AND BLADDER CANCER OUTCOMES IN MULTI-ETHNIC POPULATIONS: A CALIFORNIA CANCER REGISTRY ANALYSIS Sumeet Bhanvadia, Unwanaobong Nseyo, Sidney Roberts, Ziwei Song, Lihua Liu, Inderbir Gill, Siamak Daneshmand, and Mariana C. Stern Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Sidney RobertsSidney Roberts More articles by this author , Ziwei SongZiwei Song More articles by this author , Lihua LiuLihua Liu More articles by this author , Inderbir GillInderbir Gill More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , and Mariana C. SternMariana C. Stern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002069.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While racial disparities in bladder cancer (BC) outcomes have been described, it is unclear to what degree foreign-born status contributes to disparities among racial/ethnic minorities. We investigated clinical characteristics and survival patterns for bladder cancer (BC) among various racial/ethnic groups, factoring in nativity as compared to non-Latino Whites (NLW). METHODS: We used data from the California Cancer Registry (1995-2017) to identify BC cases among California residents diagnosed between January 1, 1977 and December 31, 2017. Latino status and country of origin were identified by the NAACCR Hispanic Identification Algorithm (NHIA) and birthplace variable. Nativity (US-born versus foreign-born) was defined based on birthplace information. Cox regression modeling was performed to determine overall cancer-specific mortality (CSM) adjusting for sex, age, stage, treatment, SES, nativity and insurance type, using non-Latino white (NLW) as the reference. RESULTS: We identified a total of 141,083 cases of all stages/grades of BC: 113461 NLW (80.4%), 13,310 Latinos (9.4%), 8529 Asians (6.0%), and 5783 non-Latino Blacks (NLB) (4.1%). Foreign-born (FB) Asians and Latinos represented 81.1% and 52.6% of their total populations, respectively. Relative to NLW, Latinos and Asians had worse clinical characteristics in terms of higher stage at presentation, tumor size, and longer time interval before treatment. FB members of both racial/’ethnic groups were more likely to be of low SES, uninsured, married, and older at diagnosis. FB Asians had higher rates of nodal and metastatic disease at presentation compared to US-born Asians. While FB Latinos (10.3%) presented at a higher stage relative to US Latinos (9.1%), there was a greater frequency of FB Latinos receiving no treatment. On adjusted regression analysis, US Latinos had the highest risk of dying of BC and FB individuals fared better than their US-born counterparts. CONCLUSIONS: Differences in BC incidence, treatment patterns and surgical outcomes were observed between FB and US-born populations among Latinos and Asians. Despite higher prevalence of adverse characteristics among FB Latinos, US-born Latinos had the worst survival outcomes. This study highlights the need for more in-depth study of outcomes within racial/ethnic subgroups. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e833-e834 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumeet Bhanvadia More articles by this author Unwanaobong Nseyo More articles by this author Sidney Roberts More articles by this author Ziwei Song More articles by this author Lihua Liu More articles by this author Inderbir Gill More articles by this author Siamak Daneshmand More articles by this author Mariana C. Stern More articles by this author Expand All Advertisement Loading ...

Latino Families' Decisions to Accept Hospice Care.

The underrepresentation of Latinos in hospice care is well-documented. A gap remains, however, in the literature's description of the factors that shape Latino families' decisions to enroll in hospice care. The need for such understanding is dire considering the shifts in population and the research evidence that Latinos experience worse end-of-life outcomes compared to non-Latino whites. This study contributes to such understanding by exploring Latino older adults' experiences with healthcare broadly and reasons for choosing hospice care specifically, including how they learned about hospice and their understanding of the service at the time of enrollment. Semi-structured interviews were conducted with 13 hospice-enrolled Latinos 65 or older, or their decision-making proxies. Qualitative data was analyzed using thematic analysis. Findings show that hospice represents a way to access services, and not necessarily a philosophy of care that Latinos understand or seek at end of life. Healthcare providers such as hospital and hospice social workers must engage in efforts to enhance advance care planning discussions and hospice education with the Latino community.

Latent Profile Analysis of Cognition in a Non-Demented Diverse Cohort: A Focus on Modifiable Cardiovascular and Lifestyle Factors.

Cognitively-defined subgroups are well-documented within neurodegeneration. We examined such profiles in diverse non-demented older adults and considered how resulting subgroups relate to modifiable factors associated with neurodegeneration. 121 non-demented (MMSE = 28.62) diverse (46%non-Latino Black, 40%non-Latino White, 15%Latino) community-dwelling adults (age = 67.7 years) completed cognitive, cardiovascular, physical activity, and diet evaluations. Latent profile analyses (LPA) employed six cognitive scores (letter fluency, letter-number sequencing, confrontational naming, 'animal' fluency, list-learning delayed recall, and recognition discriminability) to characterize cognitively-defined subgroups. Differences between resulting subgroups on cardiovascular (composite scores of overall health; specific health components including fasting blood levels) and lifestyle (sedentary behavior; moderate-to-vigorous physical activity; Mediterranean diet consumption) factors were examined using ANCOVAs adjusting for relevant confounders. Based on sample means across cognitive scores, LPA resulted in the following cognitive subgroups: 1) high-average cognition, 55%non-Latino White and 64%female participants; 2) average cognition, 58%non-Latino Black and 68%male participants; 3) lower memory, 58%non-Latino Black participants; and 4) lower executive functioning, 70%Latinos. The high-average subgroup reported significantly higher Mediterranean diet consumption than the average subgroup (p = 0.001). The lower executive functioning group had higher fasting glucose and hemoglobin A1c than all other subgroups (p-values<0.001). LPA revealed two average subgroups reflecting level differences in cognition previously reported between non-Latino White and Black adults, and two lower cognition subgroups in domains similar to those documented in neurodegeneration. These subgroups, and their differences, suggest the importance of considering social determinants of health in cognitive aging and modifiable risk.

Clinicopathologic differences and mortality among Latinos and non-Latino whites with gastric cancer at a majority-minority cancer center in South Texas.

Latino patients have a higher incidence of gastric cancer compared to non-Latino white patients nationwide, with greater disparities in South Texas. However, the impact of Latino ethnicity on mortality in gastric cancer is controversial. We evaluated clinicopathological characteristics and survival outcomes in Latino vs. non-Latino white patients at our National Cancer Institute (NCI)-designated cancer center and its affiliated hospital. We conducted a retrospective chart review of Latino and non-Latino white patients diagnosed with gastric cancer who were seen at Mays Cancer Center at the University of Texas Health in San Antonio, Texas, from 2000-2018. Median overall survival (mOS) was estimated from Kaplan-Meier curves and groups were compared with the log-rank test. A total of 193 patients met inclusion criteria and 65% (n=126) were Latino. Median age for all patients was 61 years. Female patients represented almost 50% of Latinos vs. 36% of non-Latino whites. There were no differences in Eastern Cooperative Oncology Group (ECOG) performance status, primary tumor location, stage, Helicobacter pylori status, HER2 status, or histologic subtype at diagnosis. Median overall survival was 14 months (95% CI: 13-36) for Latinos vs. 33 months (95% CI: 14 to n/a) for non-Latino whites (P=0.36). Compared to non-Latino white patients, Latino patients with gastric cancer at a majority-minority cancer center in South Texas did not have significant differences in baseline clinicopathologic features or survival outcomes. Further prospective studies are needed to evaluate epidemiologic, pathogenetic, and molecular differences in gastric cancer in order to identify variables associated with treatment efficacy and survival.

From Disparities to Progress: Cultural Reflexivity in Framing Asian American Mental Health Research

ABSTRACT This paper examines the current theory base that is explicit in research to understanding mental health disparities seen among Asian Americans. I will argue that the disparities framework is effectively insufficient due to the epistemological and ontological dominance of “mental illness” and “mental health services” via comparisons to non-Latino whites that is implicit in its methodology. Using a social constructionist conceptual framework as well as a critical discourse analysis, I will explicate the perpetuating limitations of the current disparities research agenda and propose cultural reflexivity in framing future research that may be more equitable and inclusive for Asian American health and well-being.

Increased burden of familial-associated early-onset cancer risk among minority Americans compared to non-Latino Whites.

The role of race/ethnicity in genetic predisposition of early-onset cancers can be estimated by comparing family-based cancer concordance rates among ethnic groups. We used linked California health registries to evaluate the relative cancer risks for first-degree relatives of patients diagnosed between ages 0 and 26, and the relative risks of developing distinct second primary malignancies (SPMs). From 1989 to 2015, we identified 29,631 cancer patients and 62,863 healthy family members. We calculated the standardized incident ratios (SIRs) of early-onset primary cancers diagnosed in proband siblings and mothers, as well as SPMs detected among early-onset patients. Analyses were stratified by self-identified race/ethnicity. Given probands with cancer, there were increased relative risks of any cancer for siblings and mothers (SIR = 3.32; 95% confidence interval [CI]: 2.85-3.85) and of SPMs (SIR = 7.27; 95% CI: 6.56-8.03). Given a proband with solid cancer, both Latinos (SIR = 4.98; 95% CI: 3.82-6.39) and non-Latino Blacks (SIR = 7.35; 95% CI: 3.36-13.95) exhibited significantly higher relative risk of any cancer in siblings and mothers when compared to non-Latino White subjects (SIR = 3.02; 95% CI: 2.12-4.16). For hematologic cancers, higher familial risk was evident for Asian/Pacific Islanders (SIR = 7.56; 95% CI: 3.26-14.90) compared to non-Latino whites (SIR = 2.69; 95% CI: 1.62-4.20). The data support a need for increased attention to the genetics of early-onset cancer predisposition and environmental factors in race/ethnic minority families in the United States. This work was supported by the V Foundation for funding this work (Grant FP067172).

The Affordable Care Act and Health Care Access and Utilization Among White, Asian, and Latino Immigrants in California.

The objective of this study was to examine changes in health care access and utilization for White, Asian, and Latino immigrants associated with the implementation of the Patient Protection and Affordable Care Act (ACA) in California. Using the 2011-2013 and 2015-2017 California Health Interview Survey, we examined changes in 2 health care access and 2 utilization measures among 3 immigrant racial/ethnic groups. We estimated the unadjusted and adjusted percentage point changes in the pre-ACA and post-ACA periods. Adjusted estimates were obtained using linear probability models controlling for predisposing, enabling, and need factors. After the ACA was nationally implemented in 2014, rates of insurance increased for non-Latino (NL) White, NL Asian, and Latino immigrant groups in California. Latino immigrants had the largest increase in insurance coverage (14.3 percentage points), followed by NL Asian immigrants (9.9 percentage points) and NL White immigrants (9.2 percentage points). Despite benefitting from the largest increase in insurance coverage, the proportion of insured Latino immigrants was still lower than that of NL White and NL Asian immigrants. Latino immigrants reported a small but significant decrease in the usual source of care (-2.8 percentage points) and an increase in emergency department utilization (2.9 percentage points) after the ACA. No significant changes were found after the ACA in health care access and utilization among NL White and NL Asian immigrants. Insurance coverage increased significantly for these 3 immigrant groups after the ACA. While Latino immigrants had the largest gain in insurance coverage, the proportion of Latino immigrants with insurance remained the lowest among the 3 immigrant racial/ethnic groups.

934-P: HbA1c Trajectories across Childhood through Emerging Adulthood Vary as a Function of Race Crossed with Income, Education, and Type of Health Insurance

Among youth with type 1 diabetes (T1D), non-Latino Whites, and those from higher socioeconomic status (SES) homes, typically show lower average HbA1c (A1c) levels, and slower deterioration in A1c across childhood through emerging adulthood. However, different SES metrics (income, educational achievement, type of health insurance) may have unique associations with T1D management, and the complex interplay between race/ethnicity and multiple SES metrics in T1D across development has yet to be systematically examined. This study investigated how a diverse sample of youth with T1D may vary in A1c across childhood through emerging adulthood as a function of multiple SES metrics. Medical records from a metropolitan clinic serving socioeconomically, ethnically, and racially diverse youth (N = 614; 36.7% Latino, 18.6% non-Latino White, 6.8% Black, 3% Asian/Pacific Islander, 35% Other Race/Multiracial; 48.9% Female) were coupled with US Census Tract data to index important measures of SES: Median neighborhood household income, % of the population with ≥ high school education (from US Census Tract data); type of health insurance: Private vs. Public/No Insurance (from medical records). Black youth had higher average A1c than Whites, Latinos, and Asian/Pacific Islanders, even after controlling for SES. Latinos had slower deterioration in A1c than all other racial groups across development, but this disappears after covarying SES. Income, education, and type of health insurance individually linked only to average A1c, with no associations to trajectories, but only insurance remained predictive of average A1c when all SES metrics are simultaneously covaried. Ethnic comparisons in average A1c and trajectories across development varied depending on income, education, and insurance status between groups, providing new insight for clinicians, researchers, and policymakers to help youth properly manage T1D. Disclosure D. Mello: None. J. Raymond: None. A. Torres sanchez: None. A. Main: None. D. Wiebe: None.

Neighborhood Socioeconomic Resources and Crime-Related Psychosocial Hazards, Stroke Risk, and Cognition in Older Adults.

Living in neighborhoods with lower incomes, lower education/occupational levels, and/or higher crime increases one’s risk of developing chronic health problems including cardiovascular disease risk factors and stroke. These cardiovascular health problems are known to contribute to cognitive decline and dementia. The purpose of this study was to determine the association of neighborhood socioeconomic resources and crime-related psychosocial hazards on stroke risk and cognition, hypothesizing that cardiovascular health would mediate any relationship between the neighborhood-level environment and cognition. The study evaluated 121 non-demented Chicago-area adults (~67 years; 40% non-Latino White) for cardiovascular health problems using the Framingham Stroke Risk Profile 10-year risk of stroke (FSRP-10). The cognitive domains that were tested included memory, executive functioning, and attention/information processing. Neighborhood socioeconomic resources were quantified at the census tract level (income, education, and occupation); crime-related psychosocial hazards were quantified at the point level. Structural equation modeling (SEM) did not show that the FSRP-10 mediated the relationship between neighborhood characteristics and domain-specific cognition. The SEM results did suggest that higher crime rates were associated with a higher FSRP-10 (β(105) = 2.38, p = 0.03) and that higher FSRP-10 is associated with reduced attention/information processing performance (β(105) = −0.04, p = 0.02) after accounting for neighborhood socioeconomic resources. Clinicians may wish to query not only individual but also neighborhood-level health when considering cognition.