-
Thrombosis Research Jun 2024COVID-19 has disproportionately affected racialized populations, with particular impact among individuals of Black individuals. However, it is unclear whether... (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
COVID-19 has disproportionately affected racialized populations, with particular impact among individuals of Black individuals. However, it is unclear whether disparities in venous thromboembolic (VTE) complications exist between Black individuals and those belonging to other racial groups with confirmed SARS-CoV2 infections.
OBJECTIVE
To summarize the prevalence and moderators associated with VTE among Black COVID-19 patients in minoritized settings, and to compare this to White and Asian COVID-19 patients according to sex, age, and comorbid health conditions (heart failure, cancer, obesity, hypertension).
DESIGN SETTING, AND PARTICIPANTS
A systematic search of MEDLINE, Embase, CINAHL and CENTRAL for articles or reports published from inception to February 15, 2023.
STUDY SELECTION
Reports on VTE among Black individuals infected with SARS-CoV2, in countries where Black people are considered a minority population group.
DATA EXTRACTION AND SYNTHESIS
Study characteristics and results of eligible studies were independently extracted by 2 pairs of reviewers. VTE prevalence was extracted, and risk of bias was assessed. Prevalence estimates of VTE prevalence among Black individuals with COVID19 in each study were pooled. Where studies provided race-stratified VTE prevalence among COVID19 patients, odds ratios were generated using a random-effects model.
MAIN OUTCOMES AND MEASURES
Prevalence of VTE, comprising of deep vein thrombosis and pulmonary embolism.
RESULTS
Ten studies with 66,185 Black individuals reporting the prevalence of COVID-19 associated VTE were included. Weighted median age of included studies was 47.60. Pooled prevalence of COVID-19 associated VTE was 7.2 % (95 % CI, 3.8 % - 11.5 %) among Black individuals. Among individuals with SARS-CoV2 infections, Black population had higher risks of VTE compared to their White (OR = 1.79, [95 % CI 1.28-2.53], p < .001) or Asian (OR = 2.01, [95 % CI, 1.14-3.60], p = .017) counterparts, or patients with other racial identities (OR = 2.01, [95 % CI, 1.39, 2.92]; p < .001).
CONCLUSIONS AND RELEVANCE
Black individuals with COVID-19 had substantially higher risk of VTE compared to White or Asian individuals. Given racial disparities in thrombotic disease burden related to COVID-19, medical education, research, and health policy interventions are direly needed to ensure adequate disease awareness among Black individuals, to facilitate appropriate diagnosis and treatment among Black patients with suspected and confirmed VTE, and to advocate for culturally safe VTE prevention strategies, including pre-existing inequalities to the COVID-19 pandemic that persist after the crisis.
Topics: Humans; COVID-19; Venous Thromboembolism; White People; Prevalence; SARS-CoV-2; Asian People; Female; Male; Risk Factors; Minority Groups; Black People
PubMed: 38733691
DOI: 10.1016/j.thromres.2024.05.007 -
Journal of Palliative Medicine Dec 2006Evidence suggests that racial and ethnic disparities exist in access to effective pain treatment. (Review)
Review
BACKGROUND
Evidence suggests that racial and ethnic disparities exist in access to effective pain treatment.
PURPOSE
To review evidence of these disparities and provide recommendations for care and further research.
DESIGN
Systematic review.
METHODS
We conducted a MEDLINE search using the MeSH terms of ethnic groups, minority groups, pain, analgesia, and analgesics. We included studies describing current practice patterns, utilization of available treatments, treatment outcomes, and patient and provider knowledge, attitudes, and behaviors.
RESULTS
Our search identified 35 journal articles describing the effect of patient race and ethnicity on pain assessment and management. Three studies on pain assessment revealed that minority patients are more likely to have their pain underestimated by providers and less likely to have pain scores documented in the medical record compared to whites. Eleven of 17 studies found that African Americans and Hispanics are less likely to receive opioid analgesics and more likely to have their pain untreated compared to white patients. Three studies revealed that minority patients are more likely to have negative pain management index (PMI) scores-undertreated pain-compared to whites. Patient-related, provider-related, and pharmacy-related barriers to effective pain management were identified.
CONCLUSION
The majority of studies reveal racial and ethnic disparities in access to effective pain treatment akin to disparities found in other medical services. Quality improvement initiatives that improve treatment of pain for all patients according to established guidelines should decrease disparities by race or ethnicity. Educational interventions should aim to improve patient-provider communication regarding pain and its treatment and should provide support around substance abuse issues. Further research is needed to examine pain treatment outcomes and to determine whether health care system factors lead to these disparities.
Topics: Ethnicity; Humans; Pain; United States
PubMed: 17187552
DOI: 10.1089/jpm.2006.9.1454 -
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 -
Telemedicine Journal and E-health : the... May 2017African Americans (AA) experience high levels of health disparities for several diseases, yet remain underrepresented in clinical trials and other types of research. The... (Review)
Review
BACKGROUND
African Americans (AA) experience high levels of health disparities for several diseases, yet remain underrepresented in clinical trials and other types of research. The high ownership of smartphones among AA puts them in a unique position to be recruited into e-Health/m-Health interventions.
OBJECTIVE
This article is a systematic review of the participation of AA in e-Health/m-Health interventions, the diseases/health conditions targeted, and the recruitment and retention strategies used.
MATERIALS AND METHODS
A systematic review was done with PubMed, PsycINFO, Web of Science, EBSCOhost, and CINAHL databases, as well as hand searches of 14 journals. The search was restricted to studies conducted in the United States and that were published between January 2000 and June 2016. Twenty-three distinct search terms were used.
RESULTS
After removal of duplicates, 565 studies were screened and assessed for eligibility, and 56 met the inclusion criteria. Eight studies had exclusively AA participants. Eighty percent of the studies had female participants. Participants were recruited primarily from clinics/healthcare facilities. Forty-five percent of the studies provided monetary incentives. Only five studies addressed retention of participants. The diseases/health conditions that were studied included overweight/obesity, diabetes, physical activity, cardiovascular conditions, nutrition, prenatal health, and HIV.
CONCLUSION
There was a low representation of AA in the studies in this review. Opportunities exist to engage AA in e-Health/m-Health research, but researchers must go beyond the traditional one-size-fits-all approach to determine what mixture of incentives and recruitment/retention strategies would work best for a particular health condition, population group, or community.
Topics: Adult; Black or African American; Aged; Aged, 80 and over; Biomedical Research; Female; Humans; Male; Middle Aged; Motivation; Patient Selection; Telemedicine; United States
PubMed: 27792475
DOI: 10.1089/tmj.2016.0067 -
Archives of Academic Emergency Medicine 2024Large vessel occlusion (LVO) strokes are linked to higher mortality rates and a greater risk of long-term disability. This study aimed to evaluate the diagnostic... (Review)
Review
INTRODUCTION
Large vessel occlusion (LVO) strokes are linked to higher mortality rates and a greater risk of long-term disability. This study aimed to evaluate the diagnostic performance of the Rapid Arterial Occlusion Evaluation (RACE) tool in detecting LVO through a systematic review and meta-analysis.
METHODS
A comprehensive search was conducted across online databases including PubMed, Embase, Scopus, and Web of Science, up to June 25th, 2023. Additionally, a manual search on Google and Google Scholar was performed to identify studies that assessed the diagnostic accuracy of the RACE scale in detecting LVO among patients with stroke symptoms.
RESULTS
Data extracted from 43 studies were analyzed. The optimal cut-off points were determined to be 3 and 4, with a sensitivity of 0.86 (95% confidence interval (CI): 0.78, 0.91) and specificity of 0.57 (95% CI: 0.49, 0.67) for cut-off ≥3, and a sensitivity of 0.78 (95% CI: 0.70, 0.84) and specificity of 0.68 (95% CI: 0.59, 0.75) for cut-off ≥4. Subgroup meta-regression analysis revealed significant variations in sensitivity and specificity. RACE scale's sensitivity was significantly higher in LVO detection in suspected stroke cases, in pre-hospital settings, prospective design studies, and when considering both anterior and posterior occlusions for LVO definition. RACE scale's specificity was significantly higher when evaluating confirmed stroke cases, in-hospital settings, and considering only anterior occlusions for LVO definition and retrospective design studies. Notably, RACE exhibited higher sensitivity and specificity when utilized by neurologists and physicians compared to other emergency staff. Despite these variations, our study found comparable diagnostic accuracy across different conditions.
CONCLUSION
A high level of evidence indicates that the RACE scale lacks promising diagnostic value for detection of LVOs. A sensitivity range of 0.69 to 0.86 is insufficient for a screening tool intended to aid in the diagnosis of strokes, considering the substantial morbidity and mortality associated with this condition.
PubMed: 38162382
DOI: 10.22037/aaem.v12i1.2152 -
Psychiatry Research Sep 2017The Indigenous populations of Australia and New Zealand are considered at higher risk of mood and anxiety disorders but many studies do not include direct comparisons... (Meta-Analysis)
Meta-Analysis Review
The Indigenous populations of Australia and New Zealand are considered at higher risk of mood and anxiety disorders but many studies do not include direct comparisons with similar non-Indigenous controls. We conducted a systematic search of relevant electronic databases, as well as snowballing and targeted searches of the grey literature. Studies were included for meta-analysis if they compared rates of mood and anxiety disorders between Indigenous and non-Indigenous Australians or Maori. Seven Australian and 10 NZ studies were included. Overall, Indigenous people in both countries did not have significantly higher rates of disorder. However, in terms of specific disorders, there were differences in risk by gender, country (Australia or NZ), disorder type, and prevalence (current, 12-month or lifetime). For instance, Indigenous Australians and Maori both had significantly lower rates of simple phobias (current prevalence) and Maori participants had significantly lower rates of both lifetime simple phobia and generalised anxiety disorders. By contrast, Indigenous Australians had significantly higher rates of bipolar affective disorder and social phobia (current prevalence). Generalisations regarding the risk of psychiatric disorders in Indigenous people cannot therefore be made as this varies by several factors. These include disorder type, sociodemographic factors, Indigenous origin and study method.
Topics: Adult; Anxiety Disorders; Australia; Female; Humans; Male; Mood Disorders; Native Hawaiian or Other Pacific Islander; New Zealand; Phobic Disorders; Prevalence
PubMed: 28544944
DOI: 10.1016/j.psychres.2017.05.015 -
Archives of Gerontology and Geriatrics Nov 2023Debates persist regarding the performance of existing glomerular filtration rate (GFR) estimating equations in older individuals. We performed this meta-analysis to... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Debates persist regarding the performance of existing glomerular filtration rate (GFR) estimating equations in older individuals. We performed this meta-analysis to assess the accuracy and bias of six commonly used equations, including the Chronic Kidney Disease Epidemiology Collaboration creatinine equation (CKD-EPI) and its combination with cystatin C (CKD-EPI), with the corresponding pair of the Berlin Initiative Study equations (BIS1 and BIS2) and the Full Age Spectrum equations (FAS and FAS).
METHODS
PubMed and the Cochrane Library were searched for studies comparing estimated GFR (eGFR) with measured GFR (mGFR). We analyzed the difference in P30 and bias among the six equations and investigated subgroups based on the area (Asian and non-Asian), mean age (60-74 years and ≥75 years), and levels of mean mGFR (<45 mL/min/1.73m and ≥45 mL/min/1.73m).
RESULTS
27 studies with 18,112 participants were included, all reporting P30 and bias. BIS1 and FAS exhibited significantly higher P30 than CKD-EPI. While no significant differences were observed between FAS and BIS1, or among the three combined equations in terms of either P30 or bias. Subgroup analyses revealed FAS and FAS achieved better results in most situations. However, in the subgroup of mGFR<45 mL/min/1.73m, CKD-EPI had relatively higher P30 and significantly smaller bias.
CONCLUSIONS
Overall, BIS and FAS provided relatively more accurate estimates of GFR than CKD-EPI in older adults. FAS and FAS may be better suited for various conditions, while CKD-EPI would be a better option for older individuals with impaired renal function.
Topics: Aged; Humans; Asian; Creatinine; ErbB Receptors; Glomerular Filtration Rate; Renal Insufficiency, Chronic; Middle Aged; Reproducibility of Results; Models, Biological
PubMed: 37379796
DOI: 10.1016/j.archger.2023.105107 -
Anatomical Science International Jun 2015The prevalence and distribution of the sesamoid bones in the feet has been reported in the literature with a high degree of variability. This systematic review aims to... (Meta-Analysis)
Meta-Analysis Review
The prevalence and distribution of the sesamoid bones in the feet has been reported in the literature with a high degree of variability. This systematic review aims to provide a better estimate of the frequency of the sesamoids of the foot and their association with variables such as ancestry, gender, and side. Thirty-seven studies met the inclusion criteria and were submitted for meta-analyses, sensitivity analyses and proportion difference tests, whenever possible. At the metatarsophalangeal (MTP) joint of the hallux, sesamoids were nearly always present. At the interphalangeal (IP) joint, the pooled true estimates of large-sampled studies were: (1) an overall prevalence of 22.4 %, (2) a cadaveric rate at 71.6 %, and (3) a radiological rate (based on X-ray images) of 21.1 %. The pooled partition frequencies of the hallucal medial and lateral sesamoids were 10.7 and 1.3 %, respectively. Bipartism was the most frequent partition type (92 %), followed by tripartism (7.5 %) and quadripartism (0.5 %). Middle Eastern ancestry was associated with significantly lower hallucal partition rate (P < 0.0001) and African ancestry with significantly lower prevalence of the IP sesamoid than all other ethnicities (P < 0.001). Feet with a hallux valgus deformity seemed to be associated with significantly higher rate of partition of the medial sesamoid (odds ratio = 3) than that of the normal feet. The respective values of the pooled true prevalence in adults at the MTP joint for the 2nd, 3rd, 4th and 5th toes were 1.9, 0.32, 0.9 and 13 %, respectively. There was a significantly higher prevalence of tibial sesamoids vs lateral sesamoids, with pooled odds ratio of 34.7, 8, 4.8, and 2.27, respectively. Partition was found in around 10 % of the sesamoids of the 5th MTP joint; no partition was noted in the other toes. For most 2nd-5th MTP joints, European ancestry showed the highest frequency whereas African ancestry showed the lowest; Middle Eastern ancestry was in between. No sesamoids were found at the 4th proximal IP joint and at the 4th and 5th distal IP joints. No sesamoids were found at any IP joint in the feet of Middle Eastern and African populations. The pooled rates of the IP sesamoids of the second and third toes in European populations were 1.2 % for the 2nd proximal, 0.33 % for the second distal and 0.6 % for both IP joints of the third toe. This anatomical meta-analysis yielded results that are likely to be more accurate regarding the rates of the sesamoids in the foot, their laterality and partition. It also provided solid evidence for the genetic basis of the frequency distribution among the different populations.
Topics: Adolescent; Adult; Africa; Aged; Child; Child, Preschool; Europe; Female; Foot Deformities, Congenital; Hallux Valgus; Humans; Male; Metatarsophalangeal Joint; Middle Aged; Middle East; Prevalence; Racial Groups; Sesamoid Bones; Toe Joint; Young Adult
PubMed: 24801385
DOI: 10.1007/s12565-014-0239-9 -
Women and Birth : Journal of the... Mar 2021The Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in perinatal mental health screening and the Australian Clinical Practice Guidelines...
PROBLEM
The Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in perinatal mental health screening and the Australian Clinical Practice Guidelines recommend universal use. However, screening rates are four times lower with Indigenous Australian women compared to non-Indigenous women. Difficulties have been reported using the EPDS in this context.
BACKGROUND
Evidence demonstrates the link between perinatal mental health and maternal and child outcomes. Indigenous Australian maternal and child health and wellbeing outcomes remain unacceptably poor across all measured parameters and reported psychological distress and child removal rates are increasing.
METHODS
A systematic literature review was conducted to assess the effectiveness, validity, reliability, and cultural safety of the EPDS in the Indigenous Australian context and identify the availability and suitability of any adaptations.
FINDINGS
The EPDS has not been validated for use with Indigenous Australian women.
DISCUSSION
The findings and limitations identified in this review are consistent with concerns in other countries about the cross-cultural use of the EPDS and its sensitivity in predicting risk for postnatal depression amongst Indigenous women. Where adaptations of the EPDS have been used there has been no psychometric and cultural validation beyond the remote communities in which they were developed.
CONCLUSIONS
There is no evidence to demonstrate that the EPDS in its current form and application is suitable for screening with Indigenous Australian women. Urgent work is required to evaluate and/or develop culturally meaningful screening tools that are predictive of risk for social and emotional wellbeing and perinatal mental distress in this context.
Topics: Adult; Australia; Depression, Postpartum; Female; Humans; Mass Screening; Mental Health; Native Hawaiian or Other Pacific Islander; Pregnancy; Psychiatric Status Rating Scales; Psychometrics; Reproducibility of Results
PubMed: 32144025
DOI: 10.1016/j.wombi.2020.02.007 -
Current Hypertension Reports Jul 2016The prevalence of hypertension and uncontrolled hypertension is higher among African Americans than any other ethnicity in the USA. Certain patient medical beliefs may... (Review)
Review
PURPOSE OF REVIEW
The prevalence of hypertension and uncontrolled hypertension is higher among African Americans than any other ethnicity in the USA. Certain patient medical beliefs may lead to adverse health behaviors. The aim of this study was to systematically review and narratively synthesize beliefs about hypertension among African Americans.
RECENT FINDINGS
In a narrative review of 22 studies, many participants attributed hypertension to stress and fatty foods. Hypertension was perceived to be an episodic, symptomatic disease. Many patients exhibited a strong faith in the efficacy of medications, but used them as needed to treat perceived intermittent hypertensive episodes or infrequently to avoid addiction and dependence. Home remedies were often reported to be used concurrently to treat the folk disease "high blood" or in place of medications associated with unwanted effects. Nevertheless, participants were invested in treatment of hypertension to prevent long-term complications. Trends over time suggest that beliefs about hypertension among African Americans have change significantly and now reflect the currently accepted biomedical model. African American beliefs about hypertension may frequently differ from those of healthcare professionals. These results suggest that reconciliation of differences between patient and provider expectations for disease management may improve adherence to and acceptance of medical treatments among African Americans with hypertension. Nevertheless, discordant health beliefs are common among all patients and additional work to elucidate beliefs of other patient subgroups such as age and gender is warranted.
Topics: Black or African American; Humans; Hypertension; Medication Adherence
PubMed: 27193774
DOI: 10.1007/s11906-016-0662-5