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Journal of the National Cancer Institute Jul 2023Starting in 2018, national death certificates included a new racial classification system that accounts for multiple-race decedents and separates Native Hawaiian and...
BACKGROUND
Starting in 2018, national death certificates included a new racial classification system that accounts for multiple-race decedents and separates Native Hawaiian and Pacific Islander (NHPI) individuals from Asian individuals. We estimated cancer death rates across updated racial and ethnic categories, sex, and age.
METHODS
Age-standardized US cancer mortality rates and rate ratios from 2018 to 2020 among individuals aged 20 years and older were estimated with national death certificate data by race and ethnicity, sex, age, and cancer site.
RESULTS
In 2018, there were approximately 597 000 cancer deaths, 598 000 in 2019, and 601 000 in 2020. Among men, cancer death rates were highest in Black men (298.2 per 100 000; n = 105 632), followed by White (250.8; n = 736 319), American Indian/Alaska Native (AI/AN; 249.2; n = 3376), NHPI (205.6; n = 1080), Latino (177.2; n = 66 167), and Asian (147.9; n = 26 591) men. Among women, Black women had the highest cancer death rates (206.5 per 100 000; n = 104 437), followed by NHPI (192.1; n = 1141), AI/AN (189.9; n = 3239), White (183.0; n = 646 865), Latina (128.4; n = 61 579), and Asian (111.4; n = 26 396) women. The highest death rates by age group occurred among NHPI individuals aged 20-49 years and Black individuals aged 50-69 and 70 years and older. Asian individuals had the lowest cancer death rates across age groups. Compared with Asian individuals, total cancer death rates were 39% higher in NHPI men and 73% higher in NHPI women.
CONCLUSIONS
There were striking racial and ethnic disparities in cancer death rates during 2018-2020. Separating NHPI and Asian individuals revealed large differences in cancer mortality between 2 groups that were previously combined in vital statistics data.
Topics: Female; Humans; Male; Asian; Ethnicity; Hispanic or Latino; Native Hawaiian or Other Pacific Islander; Neoplasms; United States; Racial Groups; Young Adult; Adult; Sex Factors; Race Factors; Age Factors
PubMed: 37074947
DOI: 10.1093/jnci/djad069 -
JAMA Network Open Sep 2023Using race and ethnicity in clinical prediction models can reduce or inadvertently increase racial and ethnic disparities in medical decisions.
IMPORTANCE
Using race and ethnicity in clinical prediction models can reduce or inadvertently increase racial and ethnic disparities in medical decisions.
OBJECTIVE
To compare eligibility for lung cancer screening in a contemporary representative US population by refitting the life-years gained from screening-computed tomography (LYFS-CT) model to exclude race and ethnicity vs a counterfactual eligibility approach that recalculates life expectancy for racial and ethnic minority individuals using the same covariates but substitutes White race and uses the higher predicted life expectancy, ensuring that historically underserved groups are not penalized.
DESIGN, SETTING, AND PARTICIPANTS
The 2 submodels composing LYFS-CT NoRace were refit and externally validated without race and ethnicity: the lung cancer death submodel in participants of a large clinical trial (recruited 1993-2001; followed up until December 31, 2009) who ever smoked (n = 39 180) and the all-cause mortality submodel in the National Health Interview Survey (NHIS) 1997-2001 participants aged 40 to 80 years who ever smoked (n = 74 842, followed up until December 31, 2006). Screening eligibility was examined in NHIS 2015-2018 participants aged 50 to 80 years who ever smoked. Data were analyzed from June 2021 to September 2022.
EXPOSURE
Including and removing race and ethnicity (African American, Asian American, Hispanic American, White) in each LYFS-CT submodel.
MAIN OUTCOMES AND MEASURES
By race and ethnicity: calibration of the LYFS-CT NoRace model and the counterfactual approach (ratio of expected to observed [E/O] outcomes), US individuals eligible for screening, predicted days of life gained from screening by LYFS-CT.
RESULTS
The NHIS 2015-2018 included 25 601 individuals aged 50 to 80 years who ever smoked (2769 African American, 649 Asian American, 1855 Hispanic American, and 20 328 White individuals). Removing race and ethnicity from the submodels underestimated lung cancer death risk (expected/observed [E/O], 0.72; 95% CI, 0.52-1.00) and all-cause mortality (E/O, 0.90; 95% CI, 0.86-0.94) in African American individuals. It also overestimated mortality in Hispanic American (E/O, 1.08, 95% CI, 1.00-1.16) and Asian American individuals (E/O, 1.14, 95% CI, 1.01-1.30). Consequently, the LYFS-CT NoRace model increased Hispanic American and Asian American eligibility by 108% and 73%, respectively, while reducing African American eligibility by 39%. Using LYFS-CT with the counterfactual all-cause mortality model better maintained calibration across groups and increased African American eligibility by 13% without reducing eligibility for Hispanic American and Asian American individuals.
CONCLUSIONS AND RELEVANCE
In this study, removing race and ethnicity miscalibrated LYFS-CT submodels and substantially reduced African American eligibility for lung cancer screening. Under counterfactual eligibility, no one became ineligible, and African American eligibility increased, demonstrating the potential for maintaining model accuracy while reducing disparities.
Topics: Humans; Early Detection of Cancer; Ethnicity; Hispanic or Latino; Lung Neoplasms; Minority Groups; Mass Screening; Eligibility Determination; Adult; Middle Aged; Aged; Aged, 80 and over; Models, Statistical; Race Factors; Black or African American; Asian; White; Risk Assessment; Life Expectancy
PubMed: 37721755
DOI: 10.1001/jamanetworkopen.2023.31155 -
Australasian Psychiatry : Bulletin of... Aug 2023The principles of gender equity are important to achieve the Royal Australian and New Zealand College of Psychiatrists (the College) strategic goals. (1) To present the... (Review)
Review
OBJECTIVES
The principles of gender equity are important to achieve the Royal Australian and New Zealand College of Psychiatrists (the College) strategic goals. (1) To present the data on gender equity, (2) To describe how the action plan was developed, (3) To discuss how this work aligns with a commitment to inclusion and diversity.
METHODS
Firstly, the formation of a working group with representation from across the College. Secondly, undertaking a data snapshot and discussion paper on gender equity to support consultation. Thirdly, reviewing similar action plans, a literature review, and undertaking broad consultation across the College. Finally, collating data using a thematic analysis to support the development of an action plan.
RESULTS
Data obtained on gender equity identified clear gaps in leadership roles, academic activities and awards. Our review and consultation identified themes focused on gaps in gender equity including a role for organisational leadership approach. Together this has then informed an action plan for gender equity for the College.
CONCLUSIONS
There are no simple solutions that will solve gender inequity; this requires systemic solutions to achieve meaningful change. However, the development of the action plan is a significant step towards addressing the current gender inequities.
Topics: Humans; Gender Equity; Australia; Population Groups; Leadership; Psychiatry
PubMed: 37400962
DOI: 10.1177/10398562231186126 -
BMC Health Services Research Jul 2023Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time.... (Review)
Review
BACKGROUND
Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time. However, systematic evidence synthesis is lacking in the care coordination of health services. This scoping review synthesizes evidence on different levels of care coordination of primary health care (PHC) and primary care.
METHODS
We conducted a scoping review of published evidence on healthcare coordination. PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science and Google Scholar were searched until 30 November 2022 for studies that describe care coordination/continuity of care in PHC and primary care. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies. We analysed data using a thematic analysis approach and explained themes adopting a multilevel (individual, organizational, and system) analytical framework.
RESULTS
A total of 56 studies were included in the review. Most studies were from upper-middle-income or high-income countries, primarily focusing on continuity/care coordination in primary care. Ten themes were identified in care coordination in PHC/primary care. Four themes under care coordination at the individual level were the continuity of services, linkage at different stages of health conditions (from health promotion to rehabilitation), health care from a life-course (conception to elderly), and care coordination of health services at places (family to hospitals). Five themes under organizational level care coordination included interprofessional, multidisciplinary services, community collaboration, integrated care, and information in care coordination. Finally, a theme under system-level care coordination was related to service management involving multisectoral coordination within and beyond health systems.
CONCLUSIONS
Continuity and coordination of care involve healthcare provisions from family to health facility throughout the life-course to provide a range of services. Several issues could influence multilevel care coordination, including at the individual (services or users), organizational (providers), and system (departments and sectors) levels. Health systems should focus on care coordination, ensuring types of care per the healthcare needs at different stages of health conditions by a multidisciplinary team. Coordinating multiple technical and supporting stakeholders and sectors within and beyond health sector is also vital for the continuity of care especially in resource-limited health systems and settings.
Topics: Humans; Aged; Delivery of Health Care; Continuity of Patient Care; Health Services; Population Groups; Health Facilities
PubMed: 37443006
DOI: 10.1186/s12913-023-09718-8 -
Scientific Reports Sep 2023Eyelashes evolved to protect eyes. An optimum eyelash length functions to protect eyes from external hazards such as contaminations, excessive evaporation or shear...
Eyelashes evolved to protect eyes. An optimum eyelash length functions to protect eyes from external hazards such as contaminations, excessive evaporation or shear stress from airflow. They can also be an indicator of a person's health as various congenital and noncongenital diseases can lead to short or long eyelashes. The current study aimed to extend a recent investigation on the preference for eyelash length in humans from an evolutionary adaptive perspective. Specifically, the current study tested whether the inverted-U function for eyelash length preference recently reported for White faces, generalises to other ethnicities, and whether ethnic background modulates preference for eyelash lengths. To investigate this question, men and women of Asian, Black, and White ethnicities from the U.S. rated the attractiveness of female Indian, Asian, Black, and White faces with varying eyelash lengths. The eyelashes ranged in length from no eyelashes to half the width of an eye. Results showed that Asian, Black, and White men and women preference for eyelash length followed an inverted-U function across all four ethnicities, supporting a general preference for human eyelash length that is approximately one-third the width of an eye. In addition, the results showed that the most attractive eyelashes for Black women were skewed toward a greater eyelash-length to eye-width ratio when compared to the other images. The source of this skew is presently unknown, as it could reflect a change in perceptual sensitivity to eyelash length with skin colour or changes in preference related to perceptions of participants' ethnicity.
Topics: Female; Humans; Male; Asian; Biological Evolution; Ethnicity; Eyelashes; Beauty; White; Black or African American
PubMed: 37684317
DOI: 10.1038/s41598-023-41739-5 -
Archives of Disease in Childhood Jul 2023Despite the increased policy attention on ethnic health inequities since the COVID-19 pandemic, research on ethnicity and healthcare utilisation in children has largely... (Review)
Review
BACKGROUND
Despite the increased policy attention on ethnic health inequities since the COVID-19 pandemic, research on ethnicity and healthcare utilisation in children has largely been overlooked.
OBJECTIVES
This scoping review aimed to describe and appraise the quantitative evidence on ethnic differences (unequal) and inequities (unequal, unfair and disproportionate to healthcare needs) in paediatric healthcare utilisation in the UK 2001-2021.
METHODS
We searched Embase, Medline and grey literature sources and mapped the number of studies that found differences and inequities by ethnic group and healthcare utilisation outcome. We summarised the distribution of studies across various methodological parameters.
RESULTS
The majority of the 61 included studies (n=54, 89%) identified ethnic differences or inequities in paediatric healthcare utilisation, though inequities were examined in fewer than half of studies (n=27, 44%). These studies mostly focused on primary and preventive care, and depending on whether ethnicity data were aggregated or disaggregated, findings were sometimes conflicting. Emergency and outpatient care were understudied, as were health conditions besides mental health and infectious disease. Studies used a range of ethnicity classification systems and lacked the use of theoretical frameworks. Children's ethnicity was often the explanatory factor of interest while parent/caregiver ethnicity was largely overlooked.
DISCUSSION
While the current evidence base can assist policy makers to identify inequities in paediatric healthcare utilisation among certain ethnic groups, we outline recommendations to improve the validity, generalisability and comparability of research to better understand and thereby act on ethnic inequities in paediatric healthcare.
Topics: Humans; Child; Pandemics; COVID-19; Patient Acceptance of Health Care; Ethnicity; United Kingdom
PubMed: 36344215
DOI: 10.1136/archdischild-2022-324577 -
Journal of the American Heart... Sep 2023Background The American Heart Association's Life's Essential 8 (LE8) are 8 risk factors for cardiovascular disease, with poor attainment across all racial, ethnic, and... (Comparative Study)
Comparative Study
Background The American Heart Association's Life's Essential 8 (LE8) are 8 risk factors for cardiovascular disease, with poor attainment across all racial, ethnic, and socioeconomic groups. Attainment is lowest among Americans of low socioeconomic status (SES). Evidence suggests the association of SES with LE8 may vary by race and ethnicity. Methods and Results The association of 4 SES categories (education, income-to-poverty line ratio, employment, insurance) with LE8 was computed in age-adjusted linear regression models, with an interaction term for race and ethnicity, using National Health and Nutrition Examination Survey data, years 2011 to 2018. The sample (n=13 529) had a median age of 48 years (51% female) with weighting to be representative of the US population. The magnitude of positive association of college education (relative to ≤high school) with LE8 was greater among non-Hispanic White Americans (NHWA) compared with non-Hispanic Black Americans, Hispanic Americans, and non-Hispanic Asian Americans (all interactions <0.001). NHWA had a greater magnitude of positive association of income-to-poverty line ratio with LE8, compared with non-Hispanic Black Americans, Hispanic Americans, and non-Hispanic Asian Americans (all interactions <0.001). NHWA with Medicaid compared with private insurance had a greater magnitude of negative association with LE8 compared with non-Hispanic Black Americans, non-Hispanic Asian Americans, or Hispanic Americans (all interactions <0.01). NHWA unemployed due to disability or health condition (compared with employed) had a greater magnitude of negative association with LE8 than non-Hispanic Black Americans, non-Hispanic Asian Americans, or Hispanic Americans (all interactions <0.05). Conclusions The magnitude of association of SES with LE8 is greatest among NHWA. More research is needed on SES's role in LE8 attainment in minority group populations.
Topics: Female; Humans; Male; Middle Aged; Ethnicity; Hispanic or Latino; Nutrition Surveys; Social Class; United States; White; Risk Factors; Heart Disease Risk Factors; Black or African American; Asian
PubMed: 37702137
DOI: 10.1161/JAHA.122.029254 -
JAMA Network Open Jan 2024The Hispanic and Latino population is the second largest ethnic group in the US, but associations of obesity parameters with mortality in this population remain unclear.
IMPORTANCE
The Hispanic and Latino population is the second largest ethnic group in the US, but associations of obesity parameters with mortality in this population remain unclear.
OBJECTIVE
To investigate the associations of general and central obesity with mortality among US Hispanic and Latino adults.
DESIGN, SETTING, AND PARTICIPANTS
The Hispanic Community Health Study/Study of Latinos is an ongoing, multicenter, population-based cohort study with a multistage probability sampling method performed in Hispanic and Latino adults aged 18 to 74 years with a baseline between January 1, 2008, and December 31, 2011. Active follow-up for this analyses extended from baseline through February 17, 2022. All analyses accounted for complex survey design (ie, stratification and clustering) and sampling weights to generate estimates representing the noninstitutionalized, 18- to 74-year-old Hispanic or Latino populations from selected communities.
EXPOSURES
Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), body fat percentage, waist circumference (WC), and waist to hip ratio (WHR).
MAIN OUTCOME AND MEASURE
Deaths were ascertained via death certificates, the National Death Index, and active follow-up.
RESULTS
Of 15 773 adults (mean [SE] age, 40.9 [0.3] years; 52.8% female), 686 deaths occurred during a median (IQR) follow-up of 10.0 (9.9-10.2) years. When adjusting for sociodemographic, lifestyle, and family history covariates, hazard ratios (HRs) for mortality were 1.55 (95% CI, 1.08-2.22) for a BMI of 35.0 or greater vs 18.5 to 24.9, 1.22 (95% CI, 0.92-1.64) for the highest vs lowest body fat percentage groups (defined according to sex-, age-, and Hispanic or Latino background-specific BMI distribution), 1.35 (95% CI, 0.98-1.85) for WC greater than 102 cm (men) or 88 cm (women) vs 94 cm (men) or 80 cm (women) or less, and 1.91 (95% CI, 1.28-2.86) for WHR of 0.90 (men) or 0.85 (women) or greater vs less than 0.90 (men) or 0.85 (women). Only WHR was associated with mortality with additional adjustment for major comorbidities (HR, 1.75; 95% CI, 1.17-2.62). The association of WHR with mortality was stronger among women compared with men (P = .03 for interaction), and the association between BMI and mortality was stronger among men (P = .02 for interaction). The positive association between severe obesity (BMI ≥ 35.0) and mortality was observed only among adults with WHR of 0.90 (men) or 0.85 (women) or greater but not among those with WHR below 0.90 (men) or 0.85 (women) (P = .005 for interaction) who had greater hip circumference.
CONCLUSIONS AND RELEVANCE
In this cohort of US Hispanic and Latino adults, WHR was independently associated with higher all-cause mortality regardless of BMI and prevalent comorbidities. These findings suggest that prioritizing clinical screening and intervention for WHR in this population may be an important public health strategy, with sex-specific strategies potentially being needed.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Young Adult; Cohort Studies; Hispanic or Latino; Obesity, Abdominal
PubMed: 38227314
DOI: 10.1001/jamanetworkopen.2023.51070 -
Multiple Sclerosis and Related Disorders Aug 2023Black/African American patients with multiple sclerosis (BpwMS) and Hispanic/Latino patients with multiple sclerosis (HpwMS), who historically have been underrepresented...
Demographics and baseline disease characteristics of Black and Hispanic patients with multiple sclerosis in the open-label, single-arm, multicenter, phase IV CHIMES trial.
BACKGROUND
Black/African American patients with multiple sclerosis (BpwMS) and Hispanic/Latino patients with multiple sclerosis (HpwMS), who historically have been underrepresented in multiple sclerosis (MS) clinical trials, exhibit greater disease severity and more rapid disease progression than White patients with MS (WpwMS). The lack of diversity and inclusion in clinical trials, which may be due to barriers at the system, patient and study levels, impacts the ability to effectively assess risks, benefits and treatment responses in a generalized patient population.
METHODS
CHIMES (Characterization of Ocrelizumab in Minorities With Multiple Sclerosis), an open-label, single-arm, multicenter, phase IV study of self-identified BpwMS and HpwMS aged 18-65 years with relapsing MS and an Expanded Disability Status Score (EDSS) of ≤5.5, was developed in collaboration with patients with MS, national advocacy groups and clinical researchers. Patients were enrolled at study centers across the US, including Puerto Rico, and 1 site in Kenya.
RESULTS
A total of 182 patients enrolled in CHIMES: 113 (62.1%) were BpwMS, and 69 (37.9%) were HpwMS; the mean (SD) baseline EDSS score was 2.4 (1.4), and 62.6% of patients were treatment naive. Using the pooled non-BpwMS/HpwMS group in the OPERA ocrelizumab trials as a reference population, patients enrolled in CHIMES were younger, had a higher mean body mass and had a greater T2 lesion volume but similar T2 lesion number on MRI.
CONCLUSION
BpwMS and HpwMS have been consistently underrepresented in clinical trials, limiting the understanding of disease biology and response to treatment in this population. Data from the CHIMES study revealed differences in demographics and some baseline disease characteristics and disease burden between BpwMS and HpwMS vs WpwMS. These differences could have an impact when assessing clinical outcomes in BpwMS and HpwMS.
GOV IDENTIFIER
NCT04377555.
Topics: Humans; Black or African American; Demography; Hispanic or Latino; Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Adolescent; Young Adult; Adult; Middle Aged; Aged
PubMed: 37356256
DOI: 10.1016/j.msard.2023.104794 -
Trauma, Violence & Abuse Oct 2023Children in foster care face heightened risk of adverse psychosocial and economic outcomes compared with children in the general population. Yet, the effects of foster... (Review)
Review
Children in foster care face heightened risk of adverse psychosocial and economic outcomes compared with children in the general population. Yet, the effects of foster care as an intervention are heterogeneous. Heterogeneity outcomes by race and ethnicity are of particular interest, given that Black and Indigenous youth experience foster care at higher rates than other racial/ethnic groups and experience group differences in setting, duration, and exits to permanency. This meta-regression explores racial disparities in education, employment, mental health, and behavioral outcomes during and following foster care. A systematic search of PsycINFO, ERIC, and Academic Search Complete using a series of search terms for studies published between January 2000 and June 2021 found 70 articles and 392 effect sizes that provided outcomes of US-based foster care by race/ethnicity. Findings reveal that Black foster care impacted persons (FCIPs) have 20% lower odds (95% CI: .68-.93) of achieving employment or substantial financial earnings and have 18% lower odds (95% CI: .68-1.00) of mental health concerns compared to White FCIPs. Hispanic FCIPs have 10% lower odds (95% CI: .84-.97) of achieving stable housing compared to non-Hispanic FCIPs. Moderator analyses revealed certain study features (i.e. publication type, timing of the study, location of the study, and placement status of the participants) have a significant impact on the gap between Black and non-Black and Hispanic and non-Hispanic FCIPs. The findings provide important implications for racial disparities in foster care outcomes, as well as highlight important gaps and missing information from published studies.
Topics: Adolescent; Child; Humans; Ethnicity; Foster Home Care; Hispanic or Latino; Housing; Mental Health; Psychological Well-Being; Health Status Disparities; Racial Groups; Black or African American; White
PubMed: 35773632
DOI: 10.1177/15248380221111481