-
The Oncologist Jun 2021Asian Americans are the only racial/ethnic group in the U.S. for whom cancer is the leading cause of death in men and women, unlike heart disease for all other groups.... (Review)
Review
Asian Americans are the only racial/ethnic group in the U.S. for whom cancer is the leading cause of death in men and women, unlike heart disease for all other groups. Asian Americans face a confluence of cancer risks, with high rates of cancers endemic to their countries of origin due to infectious and cultural reasons, as well as increasing rates of "Western" cancers that are due in part to assimilation to the American diet and lifestyle. Despite the clear mortality risk, Asian Americans are screened for cancers at lower rates than the majority of Americans. Solutions to eliminate the disparity in cancer care are complicated by language and cultural concerns of this very heterogeneous group. This review addresses the disparities in cancer screening, the historical causes, the potential contribution of racism, the importance of cultural perceptions of health care, and potential strategies to address a very complicated problem. Noting that the health care disparities faced by Asian Americans may be less conspicuous than the structural racism that has inflicted significant damage to the health of Black Americans over more than four centuries, this review is meant to raise awareness and to compel the medical establishment to recognize the urgent need to eliminate health disparities for all. IMPLICATIONS FOR PRACTICE: Cancer is the leading cause of death in Asian Americans, who face cancers endemic to their native countries, perhaps because of infectious and cultural factors, as well as those faced by all Americans, perhaps because of "Westernization" in terms of diet and lifestyle. Despite the mortality rates, Asian Americans have less cancer screening than other Americans. This review highlights the need to educate Asian Americans to improve cancer literacy and health care providers to understand the important cancer risks of the fastest-growing racial/ethnic group in the U.S. Eliminating disparities is critical to achieving an equitable society for all Americans.
Topics: Black or African American; Asian; Female; Health Services Accessibility; Healthcare Disparities; Hispanic or Latino; Humans; Male; Neoplasms; Racial Groups; United States
PubMed: 33683795
DOI: 10.1002/onco.13748 -
Women's Health Issues : Official... 2021Racial and ethnic disparities in rates of maternal morbidity and mortality in the United States are striking and persistent. Despite evidence that variation in the...
INTRODUCTION
Racial and ethnic disparities in rates of maternal morbidity and mortality in the United States are striking and persistent. Despite evidence that variation in the quality of care contributes substantially to these disparities, we do not sufficiently understand how experiences of perinatal care differ by race and ethnicity among women with severe maternal morbidity.
METHODS
We conducted focus groups with women who experienced a severe maternal morbidity event in a New York City hospital during their most recent pregnancy (n = 20). We organized three focus groups by self-identified race/ethnicity ([1] Black, [2] Latina, and [3] White or Asian) to detect any within- and between-group differences. Discussions were audiotaped and transcribed. The research team coded the transcripts and used content analysis to identify key themes and to compare findings across racial and ethnic groups.
RESULTS
Participants reported distressing experiences and lasting emotional consequences after having a severe childbirth complication. Many women appreciated the life-saving care they received. However, poor continuity of care, communication gaps, and a perceived lack of attentiveness to participants' physical and emotional needs led to substantial concern and disappointment in care. Black and Latina women in particular emphasized these themes.
CONCLUSIONS
This study highlights missed opportunities for improved clinician communication and continuity of care to address emotional trauma when severe obstetric complications occur, particularly for Black and Latina women. Enhancing communication to ensure that women feel heard and informed throughout the birth process and addressing implicit bias, as a part of the more systemic issue of institutionalized racism, could both decrease disparities in obstetric care quality and improve the patient experience for women of all races and ethnicities.
Topics: Black or African American; Ethnicity; Female; Humans; New York City; Peripartum Period; Pregnancy; United States; White People
PubMed: 33069559
DOI: 10.1016/j.whi.2020.09.002 -
Lancet (London, England) Sep 2023Large disparities in mortality exist across racial-ethnic groups and by location in the USA, but the extent to which racial-ethnic disparities vary by location, or how...
BACKGROUND
Large disparities in mortality exist across racial-ethnic groups and by location in the USA, but the extent to which racial-ethnic disparities vary by location, or how these patterns vary by cause of death, is not well understood. We aimed to estimate age-standardised mortality by racial-ethnic group, county, and cause of death and describe the intersection between racial-ethnic and place-based disparities in mortality in the USA, comparing patterns across health conditions.
METHODS
We applied small-area estimation models to death certificate data from the US National Vital Statistics system and population data from the US National Center for Health Statistics to estimate mortality by age, sex, county, and racial-ethnic group annually from 2000 to 2019 for 19 broad causes of death. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and generated age-standardised results using direct standardisation to the 2010 US census population.
FINDINGS
From 2000 to 2019, across 3110 US counties, racial-ethnic disparities in age-standardised mortality were noted for all causes of death considered. Mortality was substantially higher in the AIAN population (all-cause mortality 1028·2 [95% uncertainty interval 922·2-1142·3] per 100 000 population in 2019) and Black population (953·5 [947·5-958·8] per 100 000) than in the White population (802·5 [800·3-804·7] per 100 000), but substantially lower in the Asian population (442·3 [429·3-455·0] per 100 000) and Latino population (595·6 [583·7-606·8] per 100 000), and this pattern was found for most causes of death. However, there were exceptions to this pattern, and the exact order among racial-ethnic groups, magnitude of the disparity in both absolute and relative terms, and change over time in this magnitude varied considerably by cause of death. Similarly, substantial geographical variation in mortality was observed for all causes of death, both overall and within each racial-ethnic group. Racial-ethnic disparities observed at the national level reflect widespread disparities at the county level, although the magnitude of these disparities varied widely among counties. Certain patterns of disparity were nearly universal among counties; for example, in 2019, mortality was higher among the AIAN population than the White population in at least 95% of counties for skin and subcutaneous diseases (455 [97·8%] of 465 counties with unmasked estimates) and HIV/AIDS and sexually transmitted infections (458 [98·5%] counties), and mortality was higher among the Black population than the White population in nearly all counties for skin and subcutaneous diseases (1436 [96·6%] of 1486 counties), diabetes and kidney diseases (1473 [99·1%]), maternal and neonatal disorders (1486 [100·0%] counties), and HIV/AIDS and sexually transmitted infections (1486 [100·0%] counties).
INTERPRETATION
Disparities in mortality among racial-ethnic groups are ubiquitous, occurring across locations in the USA and for a wide range of health conditions. There is an urgent need to address the shared structural factors driving these widespread disparities.
FUNDING
National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, US National Institutes of Health.
Topics: Humans; Ethnicity; Health Status Disparities; United States; Mortality; Racial Groups
PubMed: 37544309
DOI: 10.1016/S0140-6736(23)01088-7 -
Australian Journal of General Practice Jul 2019
Topics: Aged; Aged, 80 and over; Healthy Aging; Humans; Population Groups
PubMed: 31256518
DOI: 10.31128/AJGP-07-19-1234e -
The Hastings Center Report May 2020Mirroring the set of questions explored in the special report in which this essay appears and through a critical Cree standpoint, this essay poses three provocations...
Mirroring the set of questions explored in the special report in which this essay appears and through a critical Cree standpoint, this essay poses three provocations intended to upend habits of thought relative to notions of goodness, biocitizenship, and the democratization of scientific pursuit. Styled as foreplay, the essay warms the reader up to the desirable possibility of being a bad biocitizen. I briefly establish the colonial conditions under which the fields of genomic science, biomedical research, and bioethics have been made possible. I then offer Indigenous Science, Technology, and Society as an alternative project aimed at disturbing the territorial, political, and morally inflected claims of nation-states and their citizens, research institutions and their researchers, and bioeconomies and their consumers to continue to possess Indigenous territories and to study Indigenous bodies while controlling the bioethical principles, protocols, and policies for doing so. The work of Indigenous STS seeks to break down the bounded knowledges of disciplinary reason and map the networked interrelations of problems inhibiting and solutions strengthening the empowerment of Indigenous peoplehoods.
Topics: Bioethics; Colonialism; Humans; Population Groups
PubMed: 32597529
DOI: 10.1002/hast.1152 -
Genes Sep 2023Health equity means the opportunity for all people and populations to attain optimal health, and it requires intentional efforts to promote fairness in patient...
Health equity means the opportunity for all people and populations to attain optimal health, and it requires intentional efforts to promote fairness in patient treatments and outcomes. Pharmacogenomic variants are genetic differences associated with how patients respond to medications, and their presence can inform treatment decisions. In this perspective, we contend that the study of pharmacogenomic variation within and between human populations-population pharmacogenomics-can and should be leveraged in support of health equity. The key observation in support of this contention is that racial and ethnic groups exhibit pronounced differences in the frequencies of numerous pharmacogenomic variants, with direct implications for clinical practice. The use of race and ethnicity to stratify pharmacogenomic risk provides a means to avoid potential harm caused by biases introduced when treatment regimens do not consider genetic differences between population groups, particularly when majority group genetic profiles are assumed to hold for minority groups. We focus on the mitigation of adverse drug reactions as an area where population pharmacogenomics can have a direct and immediate impact on public health.
Topics: Humans; Pharmacogenetics; Health Equity; Ethnicity; Pharmacogenomic Variants; Minority Groups
PubMed: 37895188
DOI: 10.3390/genes14101840 -
Frontiers in Public Health 2021The concept of "race" emerged in the 1600s with the trans-Atlantic slave trade, justifying slavery; it has been used to justify exploitation, denigration and decimation.... (Review)
Review
The concept of "race" emerged in the 1600s with the trans-Atlantic slave trade, justifying slavery; it has been used to justify exploitation, denigration and decimation. Since then, despite contrary scientific evidence, a deeply-rooted belief has taken hold that "race," indicated by, e.g., skin color or facial features, reflects fundamental biological differences. We propose that the term "race" be abandoned, substituting "ethnic group" while retaining "racism," with the goal of dismantling it. Despite scientific consensus that "race" is a social construct, in official U.S. classifications, "Hispanic"/"Latino" is an "ethnicity" while African American/Black, American Indian/Alaska Native, Asian/Pacific Islander, and European American/White are "races." There is no scientific basis for this. Each grouping reflects ancestry in a particular continent/region and shared history, e.g., the genocide and expropriation of Indigenous peoples, African Americans' enslavement, oppression and ongoing disenfranchisement, Latin America's Indigenous roots and colonization. Given migrations over millennia, each group reflects extensive genetic admixture across and within continents/regions. "Ethnicity" evokes social characteristics such as history, language, beliefs, customs. "Race" reinforces notions of inherent biological differences based on physical appearance. While not useful as a biological category, geographic ancestry is a key social category for monitoring and addressing health inequities because of racism's profound influence on health and well-being. We must continue to collect and analyze data on the population groups that have been racialized into socially constructed categories called "races." We must not, however, continue to use that term; it is not the only obstacle to dismantling racism, but it is a significant one.
Topics: Black or African American; Ethnicity; Hispanic or Latino; Humans; Native Hawaiian or Other Pacific Islander; Racism; United States
PubMed: 34557466
DOI: 10.3389/fpubh.2021.689462 -
Circulation. Arrhythmia and... May 2021
Topics: Delivery of Health Care; Health Status Disparities; Humans; Pandemics; Racial Groups
PubMed: 33993701
DOI: 10.1161/CIRCEP.121.009908 -
World Journal of Gastroenterology Jan 2021Roma people make up a significant ethnic minority in many European countries, with the vast majority living in Central and Eastern Europe. Roma are a vulnerable... (Review)
Review
Roma people make up a significant ethnic minority in many European countries, with the vast majority living in Central and Eastern Europe. Roma are a vulnerable population group in social, economic, and political terms. Frequent migrations, life in segregated communities, substandard housing, poverty, and limited access to quality health care, including low immunization coverage, affect their health status and predispose them to various diseases, including viral hepatitis. Hepatitis A, B, and E are highly prevalent among Roma and mainly associated with low socioeconomic status. In contrast, hepatitis C does not seem to be more frequent in the Roma population. Enhanced efforts should be directed towards the implementation of screening programs, preventive measures, and treatment of viral hepatitis in Roma communities throughout Europe.
Topics: Ethnicity; Europe; Europe, Eastern; Humans; Minority Groups; Risk Factors; Roma; Viruses
PubMed: 33510555
DOI: 10.3748/wjg.v27.i2.143 -
Appetite Feb 2022Red and processed meat (RPM) consumption associates directly with several unfavorable health outcomes and with environmental impact of diet. RPM consumption differs...
Red and processed meat (RPM) consumption associates directly with several unfavorable health outcomes and with environmental impact of diet. RPM consumption differs between certain population groups, and moreover, encompasses various subjective meanings. Literature on determinants of subjective importance of meat in diet (SIM), however, is scarce. Aims of this study were to determine which sociodemographic and -economic characteristics associate with SIM and RPM consumption. The study was based on the FinHealth 2017 Study. The sample comprised 4671 participants aged 18-74 years. SIM was asked with a question including five response options from "not important at all" to "very important". Habitual dietary intake including RPM consumption was studied with a food frequency questionnaire. RPM consumption level grew in parallel with SIM categories. RPM consumption was high and SIM prevailing in men, those living in rural areas, and those with low education. Women living in household with children consumed more RPM than other women but did not find meat more important. Conversely, men living in household with children found meat more important but did not consume it more than other men. Domain analyses considering individuals within the highest RPM consumption quintile revealed that the oldest age group found meat significantly less important than the youngest group. In order to be able to lower RPM consumption at population level and to move towards healthier and climate-wiser diets, it is important to identify subgroups that consume much meat but also subgroups that find meat especially important. Such dietary transition may be especially challenging to subgroups that consume much meat and also consider it important. Actions to support the dietary transition in different population groups should be developed.
Topics: Adolescent; Adult; Aged; Child; Diet; Diet Surveys; Eating; Female; Humans; Male; Meat; Middle Aged; Population Groups; Red Meat; Young Adult
PubMed: 34871587
DOI: 10.1016/j.appet.2021.105836