-
Otolaryngology--head and Neck Surgery :... Apr 2024Medical literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic... (Review)
Review
OBJECTIVE
Medical literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic black (NHB) populations. The etiology of this disparity is often attributed to inequitable access to health care and socioeconomic status (SES). However, other contributors have been reported. We performed a systematic review to better understand the multifactorial landscape driving racial disparities in HNC.
DATA SOURCES
A systematic review was conducted in Covidence following Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through November 2022 evaluating racial disparities in HNC identified 2309 publications.
REVIEW METHODS
Full texts were screened by 2 authors independently, and inconsistencies were resolved by consensus. Three hundred forty publications were ultimately selected and categorized into themes including disparities in access/SES, treatment, lifestyle, and biology. Racial groups examined included NHB and NHW patients but also included Hispanic, Native American, and Asian/Pacific Islander patients to a lesser extent.
RESULTS
Of the 340 articles, 192 focused on themes of access/SES, including access to high-quality hospitals, insurance coverage, and transportation contributing to disparate HNC outcomes. Additional themes discussed in 148 articles included incongruities in surgical recommendations, tobacco/alcohol use, human papillomavirus-associated malignancies, and race-informed silencing of tumor suppressor genes.
CONCLUSION
Differential access to care plays a significant role in racial disparities in HNC, disproportionately affecting NHB populations. However, there are other significant themes driving racial disparities. Future studies should focus on providing equitable access to care while also addressing these additional sources of disparities in HNC.
Topics: Humans; Black or African American; Ethnicity; Head and Neck Neoplasms; Healthcare Disparities; Hispanic or Latino; United States; White; Indians, North American; Asian American Native Hawaiian and Pacific Islander
PubMed: 38258967
DOI: 10.1002/ohn.653 -
JAMA Internal Medicine Jan 2023Since the onset of the COVID-19 pandemic, there have been calls for COVID-19 clinical trials to be fully representative of all demographic groups. However, limited... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Since the onset of the COVID-19 pandemic, there have been calls for COVID-19 clinical trials to be fully representative of all demographic groups. However, limited evidence is available about the sex, racial, and ethnic representation among COVID-19 prevention and treatment trials.
OBJECTIVE
To investigate whether female participants and racial and ethnic minority individuals are adequately represented in COVID-19 prevention and treatment trials in the US.
DATA SOURCES
Identified studies were registered on ClinicalTrials.gov or published in the PubMed database from October 2019 to February 2022.
STUDY SELECTION
Included studies must have provided the number of enrolled participants by sex, race, or ethnicity. Only interventional studies conducted in the US for the primary purpose of the diagnosis, prevention, or treatment of (or supportive care for) COVID-19 conditions were included.
DATA EXTRACTION AND SYNTHESIS
Data on counts of enrollments by demographic variables (sex, race, and ethnicity) and location (country and state) were abstracted. Studies were broadly categorized by primary purpose as prevention (including vaccine and diagnosis studies) vs treatment (including supportive care studies). A random effects model for single proportions was used. Trial estimates were compared with corresponding estimates of representation in the US population with COVID-19.
MAIN OUTCOMES AND MEASURES
Sex, racial, and ethnic representation in COVID-19 clinical trials compared with their representation in the US population with COVID-19.
RESULTS
Overall, 122 US-based COVID-19 clinical trials comprising 176 654 participants were analyzed. Studies were predominantly randomized trials (n = 95) for treatment of COVID-19 (n = 103). Sex, race, and ethnicity were reported in 109 (89.3%), 95 (77.9%), and 87 (71.3%) trials, respectively. Estimated representation in prevention and treatment trials vs the US population with COVID-19 was 48.9% and 44.6% vs 52.4% for female participants; 23.0% and 36.6% vs 17.7% for Hispanic or Latino participants; 7.2% and 16.5% vs 14.1% for Black participants; 3.8% and 4.6% vs 3.7% for Asian participants; 0.2% and 0.9% vs 0.2% for Native Hawaiian or Other Pacific Islander participants; and 1.3% and 1.4% vs 1.1% for American Indian or Alaska Native participants. Compared with expected rates in the COVID-19 reference population, female participants were underrepresented in treatment trials (85.1% of expected; P < .001), Black participants (53.7% of expected; P = .003) and Asian participants (64.4% of expected; P = .003) were underrepresented in prevention trials, and Hispanic or Latino participants were overrepresented in treatment trials (206.8% of expected; P < .001).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, aggregate differences in representation for several demographic groups in COVID-19 prevention and treatment trials in the US were found. Strategies to better ensure diverse representation in COVID-19 studies are needed, especially for prevention trials.
Topics: Humans; Female; United States; Ethnicity; COVID-19; Minority Groups; Pandemics; Hispanic or Latino
PubMed: 36469312
DOI: 10.1001/jamainternmed.2022.5600 -
PloS One 2021Wrongful convictions continue to occur through eyewitness misidentification. Recognising what factors, or interaction between factors, affect face-recognition is...
Wrongful convictions continue to occur through eyewitness misidentification. Recognising what factors, or interaction between factors, affect face-recognition is therefore imperative. Extensive research indicates that face-recognition accuracy is impacted by anxiety and by race. Limited research, however, has examined how these factors interact to potentially exacerbate face-recognition deficits. Brigham (2008) suggests that anxiety exacerbates other-race face-recognition deficits. Conversely, Attentional Control Theory predicts that anxiety exacerbates deficits for all faces. This systematic review examined existing studies investigating the possible interaction between anxiety and face-race to compare these theories. Recent studies included in this review found that both anxiety and race influence face-recognition accuracy but found no interaction. Potential moderators existing in reviewed studies, however, might have influenced their results. Separately, in some studies reviewed, anxiety induced during retrieval impacted recognition, contrasting with the conclusions of previous reviews. Recommendations for future research are given to address moderators potentially impacting results observed previously.
Topics: Anxiety; Attention; Facial Recognition; Humans; Racial Groups
PubMed: 34358245
DOI: 10.1371/journal.pone.0254477 -
Seminars in Perinatology Mar 2016Timely and appropriate response to severe hypertension during gestation is an important component of quality, safe care for pregnant or puerperal mothers regardless of... (Review)
Review
Timely and appropriate response to severe hypertension during gestation is an important component of quality, safe care for pregnant or puerperal mothers regardless of causation. The reduction of severe maternal morbidity and maternal mortality in the hypertensive mother is clearly enhanced by the addition of standard protocols for provider response to severe hypertension, particularly severe systolic hypertension. The program developed in New York State via the Safe Motherhood Initiative promotes the implementation of unit-specific safety bundles, especially one that is focused upon a standardized approach to handling the obstetric emergency of severe hypertension usually associated with preeclampsia/eclampsia. The comprehensive preeclampsia/eclampsia safety bundle as summarized by Drs. Moroz and colleagues is reviewed especially from the perspective of its focus on the timely and specific responses for health care providers to make when severe hypertension is detected in the pregnant patient. Evidence-based guidance to practice considerations and clinical care of patients with preeclampsia/eclampsia is embedded within the program outlined for New York State by Moroz and her District II ACOG colleagues. There is a central focus on timely and appropriate antepartum/postpartum management of severe hypertension, a core concept to lessen maternal risk for cerebral hemorrhage. Ten considerations for further integration into the New York program are suggested. Beyond blood pressure control, there is a need for systematic review of interventions and outcomes over time, attention to possible future variations of the protocol for racial/ethnic patient groups at highest risk for maternal morbidity and mortality, and the identification of biomarker(s) that further specify and quantify risk to the maternal brain and other organ systems when severe hypertension develops. Safer motherhood will happen when evidence for best practice is integrated into systems of care for all patients.
Topics: Female; Humans; Hypertension, Pregnancy-Induced; Maternal Mortality; New York; Patient Care Bundles; Patient Safety; Postnatal Care; Practice Guidelines as Topic; Pregnancy; Prenatal Care
PubMed: 26723235
DOI: 10.1053/j.semperi.2015.11.018 -
Journal of Immigrant and Minority Health Dec 2023Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among... (Review)
Review
Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.
Topics: Humans; Ethnicity; Minority Groups; Ethnic and Racial Minorities; Transients and Migrants; Qualitative Research
PubMed: 36976449
DOI: 10.1007/s10903-023-01468-3 -
Drug and Alcohol Review Sep 2022The transgenerational impacts of colonisation-inclusive of dispossession, intergenerational trauma, racism, social and economic exclusion and marginalisation-places... (Review)
Review
ISSUES
The transgenerational impacts of colonisation-inclusive of dispossession, intergenerational trauma, racism, social and economic exclusion and marginalisation-places First Nations peoples in Australia at significant risk of alcohol and other drug (AOD) use and its associated harms. However, knowledge and evidence supporting community-based AOD treatment for First Nations adults is limited. Therefore, this review aimed to examine the impact and acceptability of community-based models of AOD support for First Nations adults in Australia.
APPROACH
A systematic search of the empirical literature from the past 20 years was conducted.
KEY FINDINGS
Seventeen studies were included. Nine studies evaluated the program's impact on substance use and 10 studies assessed program acceptability (two studies evaluated both). Only three out of nine studies yielded a statistically significant reduction in substance use. Acceptable components included cultural safety, First Nations AOD workers, inclusion of family and kin, outreach and group support. Areas for improvement included greater focus on holistic wrap-around psychosocial support, increased local community participation and engagement, funding and breaking down silos.
IMPLICATIONS
Culturally safe, holistic and integrated AOD outreach support led by First Nations peoples and organisations that involves local community members may support First Nations peoples experiencing AOD concerns. These findings may inform the (re)design and (re)development of community-based AOD services for First Nations peoples.
CONCLUSION
There is a limited evidence-base for community-based AOD programs for First Nations peoples. First Nations-led research that is controlled by and co-produced with First Nations peoples is necessary to extend our understanding of community-based programs within First Nations communities.
Topics: Adult; Australia; Health Services, Indigenous; Humans; Indigenous Peoples; Native Hawaiian or Other Pacific Islander
PubMed: 35546281
DOI: 10.1111/dar.13477 -
The Laryngoscope Aug 2021The aim of this study is to assess the ethnic and racial demographics of patients enrolled in prospective chronic rhinosinusitis (CRS) studies relative to the... (Comparative Study)
Comparative Study
OBJECTIVE/HYPOTHESIS
The aim of this study is to assess the ethnic and racial demographics of patients enrolled in prospective chronic rhinosinusitis (CRS) studies relative to the corresponding geographic demographics of the United States (U.S.) census data.
STUDY DESIGN
Systematic Review and Population analysis.
METHODS
A systematic review was performed to identify CRS clinical trials, conducted in the U.S. and published between 2010 and 2020 in which patients were prospectively enrolled. Pooled racial and ethnicity data were compared to national and corresponding regional census data.
RESULTS
Eighty-three studies were included, comprising 12,027 patients. 50.4% were male and the average age was 49.2 years. 8,810 patients underwent a surgical procedure. Of the 12,027 patients, 81.67% were identified as White, 5.35% as Black, 1.27% as Asian, 0.02% as Pacific Islander, 0.12% as American Indian, and 11.57% were classified as Other. The racial and ethnic composition of the pooled study population differs significantly from the national U.S. census data with the underrepresentation of each minority population (P ≤ .0002). Regional sub-analyses yield variable results. In the Northeast and West, there was an underrepresentation of all minority populations. In the South and Midwest, Black enrollment was similar to the U.S. census data, while all other minorities were underrepresented.
CONCLUSIONS
The racial and ethnic composition of patients enrolled in prospective CRS clinical trials differs significantly from the demographics of the U.S.
POPULATION
The generalizability and external validity of findings derived from studies comprised of demographically mismatched populations has not been established. Future efforts to enroll more representative populations should be emphasized by the research community, funding bodies, and editorial boards.
LEVEL OF EVIDENCE
NA Laryngoscope, 131:1722-1728, 2021.
Topics: Chronic Disease; Clinical Trials as Topic; Demography; Ethnicity; Female; Geography; Healthcare Disparities; Humans; Male; Middle Aged; Minority Groups; Prospective Studies; Rhinitis; Sinusitis; Social Class; United States
PubMed: 33493376
DOI: 10.1002/lary.29371 -
CJC Open Dec 2021Data are limited regarding the use of implantable cardioverter-defibrillators (ICDs) in diverse populations. This study explores cardiovascular (CV) outcomes and... (Review)
Review
BACKGROUND
Data are limited regarding the use of implantable cardioverter-defibrillators (ICDs) in diverse populations. This study explores cardiovascular (CV) outcomes and mortality from ICD randomized controlled trials (RCTs), by sex, race, and age.
METHODS
Five electronic databases (PubMed, Emcare, Embase, MEDLINE, and Cumulative Index to Nursing & Allied Health Literature CINAHL) were searched for dates from their inception to July 12, 2021, for RCTs of ICD therapy in adult patients. Data were analyzed for clinical outcomes, including all-cause or CV death, and heart failure hospitalization (HFH).
RESULTS
Among 5 RCTs (mean age: 63 years; 78% male; 76% White) with moderate overall risk of bias, clinical outcomes in patients with an ICD (n = 3260) vs a control group (n = 3685) were compared. No between-group sex differences were observed for all-cause death (odds ratio [OR] 0.86, = 0.51), CV death (OR 0.98, = 0.96), HFH (OR 0.95, = 0.87), or HFH and all-cause death (OR 0.83, = 0.51) in the ICD group, in a comparison of male vs female sex. All-cause death (OR 1.20, = 0.67) did not differ for White vs Black patients receiving ICD therapy. Outcomes data for other non-White, non-Black race groups were often unreported. Most RCTs originated in North America, had male leadership, and were evenly sponsored by industry vs peer-reviewed funding.
CONCLUSIONS
Outcomes data are sparse, by sex, race, and age, in current RCTs evaluating ICD therapy. Although ICD patient outcomes did not significantly differ by sex or race, improved data analyses and reporting are needed to determine the relationship between these sociocultural factors and clinical outcomes among distinct ICD patient cohorts.
PubMed: 34993451
DOI: 10.1016/j.cjco.2021.09.015 -
Journal of Autism and Developmental... Oct 2018Interventions designed to decrease problem behavior for students with ASD are critical and may be differentially important for students from minority groups as those... (Review)
Review
Interventions designed to decrease problem behavior for students with ASD are critical and may be differentially important for students from minority groups as those students tend to be assigned more negative outcomes related to problem behavior (e.g., suspensions). School-based interventions intended to decrease problem behavior for individuals with ASD were reviewed; 46 articles including 84 single case designs and 87 participants were analyzed regarding participant demographics, settings and implementers, intervention components, and study characteristics. We assessed outcomes for 55 demonstration designs with adequate rigor. Most research was conducted with students in segregated settings and, although race and ethnicity were rarely reported, proportions were different from other reviews in that children from some minority groups were overrepresented.
Topics: Adolescent; Autism Spectrum Disorder; Child; Demography; Female; Humans; Male; Minority Groups; Problem Behavior; Schools; Students; Treatment Outcome
PubMed: 29704142
DOI: 10.1007/s10803-018-3591-0 -
European Journal of Pain (London,... Apr 2023There is a substantial gap between evidence and clinical care for low back pain (LBP) worldwide despite recommendations of best practice specified in clinical practice... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVE
There is a substantial gap between evidence and clinical care for low back pain (LBP) worldwide despite recommendations of best practice specified in clinical practice guidelines. The aim of this systematic review was to identify disparities associated with race or ethnicity in the use of lumbar imaging, opioid analgesics, and spinal surgery in people with LBP.
DATABASES AND DATA TREATMENT
We included observational studies which compared the use of lumbar imaging, opioid analgesics, and spinal surgery for the management of non-serious LBP between people from different racial/ethnic populations. We searched in MEDLINE, EMBASE and CINAHL from January 2000 to June 2021. Risk of bias of included studies was appraised in six domains. For each type of care, we pooled data stratified by race and ethnicity using random effects models.
RESULTS
We identified 13 eligible studies; all conducted in the United States. Hispanic/Latino (OR 0.69, 95%CI 0.49-0.96) and Black/African American (OR 0.59, 95%CI 0.46-0.75) people with LBP were less likely to be prescribed opioid analgesics than White people. Black/African Americans were less likely to undergo or be recommended spinal surgery for LBP (OR 0.47, 95%CI 0.33-0.67) than White people. There was a lack of high certainty evidence on racial/ethnic disparities in the use of lumbar imaging.
CONCLUSION
This review reveals lower rate of the use of guideline-discordant care, especially opioid prescription and spinal surgery, in racial/ethnic minority populations with LBP in the United States. Future studies in other countries evaluating care equity for LBP are warranted. PROSPERO Registration ID: CRD42021260668.
SIGNIFICANCE
This systematic review and meta-analysis revealed that people with low back pain from the minority racial/ethnic backgrounds were less likely to be prescribed opioid analgesics and undergo spinal surgery than the majority counterparts. Strategic interventions to improve the access to, and the value of, clinical care for minority populations with low back pain are warranted.
Topics: Humans; United States; Analgesics, Opioid; Ethnicity; Low Back Pain; Minority Groups; Racial Groups
PubMed: 36585947
DOI: 10.1002/ejp.2075