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Medical Care Sep 2014The decision to perform orthopedic surgery requires substantial discretion and judgment. Similar conditions have been associated with health care disparities in other... (Review)
Review
BACKGROUND
The decision to perform orthopedic surgery requires substantial discretion and judgment. Similar conditions have been associated with health care disparities in other fields, but the extent of racial and ethnic disparities in orthopedics is unknown.
OBJECTIVE
To evaluate the quality of extant orthopedic literature on health care disparities.
RESEARCH DESIGN
This study is a systematic review.
SUBJECTS
Eligible studies reported complications and/or mortality stratified by minority group after orthopedic surgery in an American population.
MEASURES
Queries of PubMed, Embase, Scopus, and Web of Science were performed. Included papers were abstracted regarding complication and/or mortality rates for whites and minority populations, statistical findings, and whether a health care disparity was reported. Statistical associations between study characteristics and the identification of disparities were evaluated using the χ test.
RESULTS
The literature search returned 2604 studies, of which 33 met inclusion criteria. All but 3 works dealt with spine surgery or joint replacement. Twenty-one publications (64%) documented health care disparities. Forty-four percent of efforts investigating outcomes for Hispanics and 36% of works documenting results for non-whites recorded a disparity. Investigations reporting on African Americans were significantly more likely to identify health care inequalities (77%) as compared with non-white (P=0.02) cohorts.
CONCLUSIONS
Patients from racial and ethnic minority populations seem to be at increased risk of complications and/or mortality following spine surgical or joint replacement procedures. There is insufficient evidence to support generalization to the entire orthopedic field. Studies specific to African American patients identify health care disparities at a significantly higher rate than those utilizing non-white cohorts.
Topics: Ethnicity; Healthcare Disparities; Humans; Orthopedic Procedures; Postoperative Complications; Racial Groups; Retrospective Studies
PubMed: 25100230
DOI: 10.1097/MLR.0000000000000177 -
Journal of Immigrant and Minority Health Apr 2016We systematically reviewed studies to identify the association between acculturation and self-rated health (SRH) and the impact of nativity and language use in Asian and... (Comparative Study)
Comparative Study Review
We systematically reviewed studies to identify the association between acculturation and self-rated health (SRH) and the impact of nativity and language use in Asian and Hispanic adult immigrants. Six electronic databases were searched. Data on nativity and limited English proficiency (LEP) was extracted and analyzed. Nine studies met review criteria. A positive association between acculturation and fair/poor SRH among Asians and Hispanics was found. For both Asians and Hispanics, six out of eight studies showed nativity and all three studies reporting LEP were associated with worse SRH compared to whites. Nativity and LEP were found to be risk factors for reporting worse SRH in Hispanics compared to Asians. The degree of association between nativity and LEP and worse SRH was found to vary by Asian and Hispanic subgroup. Further studies are needed to accurately assess the health status of these populations, which will be essential to eliminating disparities.
Topics: Acculturation; Adult; Asian; Emigrants and Immigrants; Female; Health Status; Hispanic or Latino; Humans; Male; Self Report; United States
PubMed: 25894534
DOI: 10.1007/s10903-015-0208-y -
International Journal of Environmental... Mar 2021(1) Background: This systematic review was conducted to identify cancer patient experiences, and the impact of out-of-pocket costs and financial burden in Australia. (2)... (Review)
Review
(1) Background: This systematic review was conducted to identify cancer patient experiences, and the impact of out-of-pocket costs and financial burden in Australia. (2) Methods: A systematic review, following the Preferring Reporting Items for Systematic Reviews and Meta-Analyses, was conducted. Cumulative Index of Nursing and Allied Health Literature and PubMed were searched. The primary outcome was financial burden among cancer patients and their families in Australia. The secondary outcome was out-of-pocket costs associated with cancer care and treatment within the population sample, and the impact of financial burden. (3) Results: Nineteen studies were included, covering more than 70,000 Australians affected by cancer. Out-of-pocket costs varied by cancer type and ranged from an average of AUD 977 for breast cancer and lymphoedema patients to AUD 11,077 for prostate cancer patients. Younger aged patients (≤65 years), Aboriginal and Torres Strait Islander people, people in rural and/or remote areas, households with low income, those who were unemployed and people with private health insurance were at increased risk of experiencing out-of-pocket costs, financial burden or a combination of both. (4) Conclusions: Australians diagnosed with cancer frequently experience financial burden, and the health and financial consequences are significant. Focusing efforts on the costs of care and options about where to have care within the context of informed decisions about cancer care is necessary.
Topics: Aged; Australia; Health Expenditures; Humans; Male; Native Hawaiian or Other Pacific Islander; Neoplasms; Population Groups; Rural Population
PubMed: 33801282
DOI: 10.3390/ijerph18052422 -
Diabetes & Metabolic Syndrome 2019To carry out a systematic review to identify the prevalence of overweight and obesity in the adult indigenous population in Brazil. The databases used were PubMed,... (Meta-Analysis)
Meta-Analysis
To carry out a systematic review to identify the prevalence of overweight and obesity in the adult indigenous population in Brazil. The databases used were PubMed, Scopus, Virtual Health Library (VHL), and Science Direct, with the following search strategy: "overweight" OR "obesity" AND "indigenous" OR "tribe" AND "Brazil". For the meta-analysis, RStudio software was used. Were 22 articles included. The combined effect of the meta-analysis studies showed a global prevalence of overweight and obesity of 45%. Approximately half (45%) of indigenous Brazilian adults have excess weight. These findings highlight the need to implement public policies for the prevention and treatment of these morbidities.
Topics: Adult; Brazil; Databases, Factual; Humans; Obesity; Overweight; Population Groups; Prevalence
PubMed: 31235082
DOI: 10.1016/j.dsx.2019.03.024 -
Expert Review of Cardiovascular Therapy Apr 2017Previous studies have demonstrated higher rates of peripheral arterial disease (PAD) in blacks and lower in Asians compared to whites. The aim of this study is to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous studies have demonstrated higher rates of peripheral arterial disease (PAD) in blacks and lower in Asians compared to whites. The aim of this study is to undertake a comprehensive review of literature on ethnic differences in the epidemiology of PAD.
METHODS
A systemic review and meta-analysis included studies reporting PAD prevalence in general or diabetic populations, and comparing PAD prevalence in ethnic groups.
RESULTS
Mean prevalence of PAD in general population for whites, blacks and Asians was 3.5%, 6.7% and 3.7% respectively. Meta-analysis demonstrated higher prevalence of PAD in blacks (p < 0.001) and lower amongst Asians (p < 0.001), compared to whites. In diabetic population, the mean prevalence of PAD for whites, blacks, east Asians and south Asians was 17%, 25.3%, 13.5% and 7.6% respectively. In diabetic population, south Asians had a lower PAD prevalence (p < 0.001) compared to whites; there was no significant difference between blacks and whites. Overall females have higher PAD rates, in general (3.8% vs 3.2%; p < 0.001) and in diabetic population (13.7% vs 10%; p < 0.001).
CONCLUSION
Blacks are vulnerable to PAD, in contrast to Asians who have lower prevalence of PAD when compared to whites. Further research is needed in order to identify the factors that generate this difference.
Topics: Asian People; Black People; Diabetes Mellitus; Ethnicity; Female; Humans; Male; Peripheral Arterial Disease; Prevalence; Sex Factors; White People
PubMed: 28290228
DOI: 10.1080/14779072.2017.1305890 -
JAMA Psychiatry Jan 2021As stated in the DSM-5, it is generally reported that the prevalence of attention-deficit/hyperactivity disorder (ADHD) is lower among Black individuals compared with... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
As stated in the DSM-5, it is generally reported that the prevalence of attention-deficit/hyperactivity disorder (ADHD) is lower among Black individuals compared with the general population. However, Black individuals living in countries where they are considered a minority population group (eg, in Northern America and Europe) are underrepresented in studies evaluating ADHD.
OBJECTIVE
To estimate the pooled prevalence of ADHD and identify associated risk factors among US Black individuals.
DATA SOURCES
This systematic review and meta-analysis identified peer-reviewed studies published until October 18, 2019, using the APA PsycInfo, MEDLINE, Embase, Cochrane CENTRAL, CINAHL, ERIC, and Education Source databases.
STUDY SELECTION
Eligible trials were published in French or English, had empirical data on the prevalence of ADHD in samples or subsamples of Black people, and were conducted in countries with Black minority populations. All studies were assessed and passed quality evaluation.
DATA EXTRACTION AND SYNTHESIS
The PRISMA guideline was used for extracting and reporting data. Random-effects meta-analyses were generated to estimate the prevalence of ADHD among Black individuals using the metafor package in R.
MAIN OUTCOMES AND MEASURES
Prevalence and risk factors associated with ADHD among Black individuals were identified.
RESULTS
A total of 24 independent samples and subsamples from 21 studies published between 1979 and 2020 (154 818 Black participants) were included in this systematic review and meta-analysis. All included studies were conducted in the US. Two studies were conducted assessing adults (aged 18 years or older), 8 assessing children (0-12 years), 1 assessing adolescents (aged 13-17 years), and 13 assessing both children and adolescents. The pooled prevalence of ADHD was 14.54% (95% CI, 10.64%-19.56%). In a narrative review of the studies in this analysis, some studies found risk factors associated with ADHD, such as sociodemographic characteristics (age, sex, race, and socioeconomic status), familial factors, environmental factors, and risk behaviors, but the data did not permit a moderation analysis to assess these findings in this study.
CONCLUSIONS AND RELEVANCE
Contrary to what is stated in the DSM-5, the results of this systematic review and meta-analysis suggest that Black individuals are at higher risk for ADHD diagnoses than the general US population. These results highlight a need to increase ADHD assessment and monitoring among Black individuals from different social backgrounds. They also higlight the importance of establishing accurate diagnoses and culturally appropriate care.
Topics: Black or African American; Attention Deficit Disorder with Hyperactivity; Humans; Prevalence; Risk Factors; United States
PubMed: 32902608
DOI: 10.1001/jamapsychiatry.2020.2788 -
Journal of Palliative Care Jul 2023To synthesize evidence regarding Chinese diasporas' understanding, experience, and factors influencing engagement with advance care planning. A systematic integrative... (Review)
Review
To synthesize evidence regarding Chinese diasporas' understanding, experience, and factors influencing engagement with advance care planning. A systematic integrative review using content analysis. Seven electronic databases (Embase, CINAHL, SCOPUS, Web of Science, Medline (OVID), PsycINFo, and The Cochrane Library) and gray resources were searched for studies from January 1990 to March 2022. Study quality appraisal was undertaken. 27 articles were identified and rated as moderate to good. Two overarching and interrelated themes were identified, " and "." There are low levels of awareness, knowledge and engagement with advance care planning for Chinese diaspora. Findings highlight that this is influenced by two key factors. First, the geographic context and legal, cultural, and social systems within which the Chinese diasporas are living act as a potential catalyst to enhance awareness and engagement with advance care planning. Second, aspects of Chinese diasporas' original culture, such as filial piety and a taboo surrounding death, were reported to negatively affect the promotion and engagement of advance care planning. Chinese diasporas are intermediaries between two divergent cultures that intertwine to strongly influence engagement with advance care planning. Hence, a bespoke culturally tailored approach should be accommodated in future research and practice for Chinese communities in multicultural countries to further advance palliative and end-of-life care awareness among this group.
Topics: Humans; East Asian People; Advance Care Planning; Terminal Care; Asian People
PubMed: 36843565
DOI: 10.1177/08258597231158321 -
Pediatrics Apr 2010This technical report reviews and synthesizes the published literature on racial/ethnic disparities in children's health and health care. (Review)
Review
OBJECTIVE
This technical report reviews and synthesizes the published literature on racial/ethnic disparities in children's health and health care.
METHODS
A systematic review of the literature was conducted for articles published between 1950 and March 2007. Inclusion criteria were peer-reviewed, original research articles in English on racial/ethnic disparities in the health and health care of US children. Search terms used included "child," "disparities," and the Index Medicus terms for each racial/ethnic minority group.
RESULTS
Of 781 articles initially reviewed, 111 met inclusion criteria and constituted the final database. Review of the literature revealed that racial/ethnic disparities in children's health and health care are quite extensive, pervasive, and persistent. Disparities were noted across the spectrum of health and health care, including in mortality rates, access to care and use of services, prevention and population health, health status, adolescent health, chronic diseases, special health care needs, quality of care, and organ transplantation. Mortality-rate disparities were noted for children in all 4 major US racial/ethnic minority groups, including substantially greater risks than white children of all-cause mortality; death from drowning, from acute lymphoblastic leukemia, and after congenital heart defect surgery; and an earlier median age at death for those with Down syndrome and congenital heart defects. Certain methodologic flaws were commonly observed among excluded studies, including failure to evaluate children separately from adults (22%), combining all nonwhite children into 1 group (9%), and failure to provide a white comparison group (8%). Among studies in the final database, 22% did not perform multivariable or stratified analyses to ensure that disparities persisted after adjustment for potential confounders.
CONCLUSIONS
Racial/ethnic disparities in children's health and health care are extensive, pervasive, and persistent, and occur across the spectrum of health and health care. Methodologic flaws were identified in how such disparities are sometimes documented and analyzed. Optimal health and health care for all children will require recognition of disparities as pervasive problems, methodologically sound disparities studies, and rigorous evaluation of disparities interventions.
Topics: Child; Delivery of Health Care; Ethnicity; Health Services Accessibility; Health Services Needs and Demand; Health Status Disparities; Healthcare Disparities; Humans; Racial Groups; Socioeconomic Factors
PubMed: 20351000
DOI: 10.1542/peds.2010-0188 -
Internal and Emergency Medicine Apr 2016Despite the large differences in the epidemiology of hypertension across Europe, treatment strategies are similar for national populations of white European descent.... (Review)
Review
Despite the large differences in the epidemiology of hypertension across Europe, treatment strategies are similar for national populations of white European descent. However, hypertensive patients of African or South Asian ethnicity may require ethnic-specific approaches, as these population subgroups tend to have higher blood pressure at an earlier age that is more difficult to control, a higher occurrence of diabetes, and more target organ damage with earlier cardiovascular mortality. Therefore, we systematically reviewed the evidence on antihypertensive drug treatment in South Asian and African ethnicity patients. We used the Cochrane systematic review methodology to retrieve trials in electronic databases including CENTRAL, PubMed, and Embase from their inception through November 2015; and with handsearch. We retrieved 4596 reports that yielded 35 trials with 7 classes of antihypertensive drugs in 25,540 African ethnicity patients. Aside from the well-known blood pressure efficacy of calcium channel blockers and diuretics, with lesser effect of ACE inhibitors and beta-blockers, nebivolol was not more effective than placebo in reducing systolic blood pressure levels. Trials with morbidity and mortality outcomes indicated that lisinopril and losartan-based therapy were associated with a greater incidence of stroke and sudden death. Furthermore, 1581 reports yielded 16 randomized controlled trials with blood pressure outcomes in 1719 South Asian hypertensive patients. In contrast with the studies in African ethnicity patients, there were no significant differences in blood pressure lowering efficacy between drugs, and no trials available with mortality outcomes. In conclusion, in patients of African ethnicity, treatment initiated with ACE inhibitor or angiotensin II receptor blocker monotherapy was associated with adverse cardiovascular outcomes. We found no evidence of different efficacy of antihypertensive drugs in South Asians, but there is a need for trials with morbidity and mortality outcomes. Screening for cardiovascular risk at a younger age, treating hypertension at lower thresholds, and new delivery models to find, treat and follow hypertensives in the community may help reduce the excess cardiovascular mortality in these high-risk groups.
Topics: Adrenergic beta-Antagonists; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Asian People; Black People; Calcium Channel Blockers; Diuretics; Europe; Female; Humans; Hypertension; Male; Middle Aged; Stroke
PubMed: 27026378
DOI: 10.1007/s11739-016-1422-x -
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