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American Journal of Reproductive... May 2023Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, evidence suggests racial and ethnic disparities in COVID-19-related outcomes. Given these disparities,... (Review)
Review
Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, evidence suggests racial and ethnic disparities in COVID-19-related outcomes. Given these disparities, it is important to understand how such patterns may translate to high-risk cohorts, including obstetric patients. A PubMed search was performed to identify studies assessing pregnancy, neonatal, and other health-related complications by race or ethnicity in obstetric patients with COVID-19 infection. Forty articles were included in our analysis based on novelty, relevance, and redundancy. These articles revealed that Black and Hispanic obstetric patients present an increased risk for SARS-CoV-2 infection and maternal mortality; racial and ethnic minority patients, particularly those of Black and Asian backgrounds, are at increased risk for hospitalization and ICU admission; racial and ethnic minority groups, in particular Black patients, have an increased risk for mechanical ventilation; Black and Hispanic patients are more likely to experience dyspnea; Hispanic patients showed higher rates of pneumonia; and Black patients present an increased risk of acute respiratory distress syndrome (ARDS). There is conflicting literature on the relationship between race and ethnicity and various pregnancy and neonatal outcomes. Several factors may underly the racial and ethnic disparities observed in the obstetric population, including biological mechanisms and social determinants of health.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Black or African American; COVID-19; Ethnicity; Minority Groups; SARS-CoV-2; Hispanic or Latino; Racial Groups
PubMed: 36991562
DOI: 10.1111/aji.13698 -
JAMA Cardiology Sep 2023To address systemic disparities in biomedical research, the All of Us (AoU) Research Program was created to identify the root causes and consequences of health outcomes...
IMPORTANCE
To address systemic disparities in biomedical research, the All of Us (AoU) Research Program was created to identify the root causes and consequences of health outcomes in the US. However, the extent of AoU's racial and ethnic diversity is unknown.
OBJECTIVE
To quantify representation of key racial and ethnic groups in the accruing AoU nationwide health cohort and compare with their actual representation in the US.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study compared the AoU program from May 2017 to June 2022 for individuals 18 years and older with the Decennial Survey 2020 (DEC) collected by the US Census Bureau.
EXPOSURES
Representation of non-Hispanic Asian, non-Hispanic Black or African American, Hispanic or Latino, non-Hispanic White, and uncategorized or multiple races in AoU.
MAIN OUTCOMES AND MEASURES
The extent of underrepresentation or overrepresentation of each racial group in the AoU program at both nationwide and state-level relative to DEC.
RESULTS
Of the 358 705 US adults in the AoU to date, individuals identified with the following race and ethnicity categories: 12 710 non-Hispanic Asian (3.5%), 73 348 non-Hispanic Black or African American (20.5%), 58 488 Hispanic or Latino (16.3%), 205 457 non-Hispanic White (57.3%), and 8702 uncategorized or reporting multiple categories (2.4%). Of 355 413 participants with available sex at birth and age data, 218 981 (61.6%) were female and had a mean (SD) age of 53.1 (17.0) years, 136 037 (38.28%) were male and had a mean (SD) age of 56.7 (17.0) years, and 395 reported nonbinary sex (0.1%), with a mean (SD) age of 55.4 (15.8) years. Compared with the referent US, non-Hispanic Black or African American individuals were overrepresented in the AoU by 8.73% (AoU, 20.5% [73 348 of 358 705] vs DEC, 11.7% [30 266 080 of 258 343 281]) and by relative scale, 1.94-fold. Non-Hispanic White individuals accounted for the greatest participation in the AoU with generally consistent dominance across all regions yet numerically underrepresented by absolute difference of -3.54% (95% CI, -3.70 to -3.38). Uncategorized or multiracial group in the AoU (2.4% [8702 of 358 705]) was 0.43-fold likely to be represented relative to the DEC (4.6% [11 922 096 of 258 343 281]) with an absolute difference of -2.19% (95% CI, -2.24 to -2.14). Moreover, non-Hispanic Asian individuals were underrepresented by -2.54% (95% CI, -2.60 to -2.48) prominently in most states. Individuals identifying as Hispanic or Latino were nominally underrepresented by -0.46% (95% CI, -0.58 to -0.34) (AoU, 16.3% [58 488 of 358 705] vs DEC, 16.8% [43 322 792 of 258 343 281]).
CONCLUSIONS AND RELEVANCE
Recruitment trends for the ongoing AoU show relatively improved representation of some major race groups with geographic trends. These findings underscore the need to further tailor and augment recruitment and participation initiatives for diverse populations.
Topics: Adult; Female; Humans; Male; Middle Aged; Cohort Studies; Ethnicity; Hispanic or Latino; Population Health; Racial Groups; United States; Asian; Black or African American; White
PubMed: 37585212
DOI: 10.1001/jamacardio.2023.2411 -
Alcohol and Alcoholism (Oxford,... Sep 2023Co-use of multiple drugs may prolong or increase heavy drinking, even for individuals with health conditions adversely affected by it. Patterns of alcohol and drug use... (Comparative Study)
Comparative Study
Co-use of multiple drugs may prolong or increase heavy drinking, even for individuals with health conditions adversely affected by it. Patterns of alcohol and drug use may vary across racial/ethnic groups, with differential implications for health. This study examines racial/ethnic differences in the associations between risky drinking and other drug use in adults with diabetes, hypertension, heart disease, or cancer. Multiple logistic regression modeling, stratified by condition, was performed using a nationally representative sample of adults drawn from the 2015 to 2019 National Survey on Drug and Health. The outcome was risky drinking (consuming more than 7/14 drinks weekly). Other drugs considered were tobacco, marijuana, illicit drugs, and non-medical prescription drugs. Covariates included age, sex, education, income, marital/cohabitation status, health insurance coverage, and self-rated health status. Each drug category was positively associated with risky drinking across all four conditions. Racial/ethnic minority adults were less likely than White adults to engage in risky drinking, with this pattern most consistent for those with hypertension. Other drug use in minority adults (i.e. tobacco and illicit drug use in Black and Hispanic adults, and marijuana and prescription drug use in Asian adults) was associated with disproportionately greater odds of risky drinking compared with White adults. This pattern was more prominent for those with a heart condition, and not found for those with cancer. Future interventions might address co-use of alcohol and other drugs in adults with chronic conditions, with special attention to racial/ethnic minority adults.
Topics: Adult; Humans; Chronic Disease; Ethanol; Ethnicity; Hispanic or Latino; Minority Groups; Substance-Related Disorders; United States; White; Black or African American; Asian; Racial Groups
PubMed: 37258041
DOI: 10.1093/alcalc/agad024 -
Clinical Journal of the American... Feb 2022Black Americans and other racially and ethnically minoritized individuals are disproportionately burdened by higher morbidity and mortality from kidney disease when...
Black Americans and other racially and ethnically minoritized individuals are disproportionately burdened by higher morbidity and mortality from kidney disease when compared with their White peers. Yet, kidney researchers and clinicians have struggled to fully explain or rectify causes of these inequalities. Many studies have sought to identify hypothesized genetic and/or ancestral origins of biologic or behavioral deficits as singular explanations for racial and ethnic inequalities in kidney health. However, these approaches reinforce essentialist beliefs that racial groups are inherently biologically and behaviorally different. These approaches also often conflate the complex interactions of individual-level biologic differences with aggregated population-level disparities that are due to structural racism (, sociopolitical policies and practices that created and perpetuate harmful health outcomes through inequities of opportunities and resources). We review foundational misconceptions about race, racism, genetics, and ancestry that shape research and clinical practice with a focus on kidney disease and related health outcomes. We also provide recommendations on how to embed key equity-enhancing concepts, terms, and principles into research, clinical practice, and medical publishing standards.
Topics: Biomedical Research; Guidelines as Topic; Healthcare Disparities; Humans; Kidney Diseases; Racial Groups; Racism; United States
PubMed: 34789476
DOI: 10.2215/CJN.04890421 -
Nature Reviews. Genetics Oct 2004The renewed emphasis on population-specific genetic variation, exemplified most prominently by the International HapMap Project, is complicated by a longstanding,... (Review)
Review
The renewed emphasis on population-specific genetic variation, exemplified most prominently by the International HapMap Project, is complicated by a longstanding, uncritical reliance on existing population categories in genetic research. Race and other pre-existing population definitions (ethnicity, religion, language, nationality, culture and so on) tend to be contentious concepts that have polarized discussions about the ethics and science of research into population-specific human genetic variation. By contrast, a broader consideration of the multiple historical sources of genetic variation provides a whole-genome perspective on the ways i n which existing population definitions do, and do not, account for how genetic variation is distributed among individuals. Although genetics will continue to rely on analytical tools that make use of particular population histories, it is important to interpret findings in a broader genomic context.
Topics: Genetic Variation; Genetics, Population; Genome, Human; Genomics; Humans; Population Dynamics; Racial Groups
PubMed: 15510170
DOI: 10.1038/nrg1452 -
Journal of Racial and Ethnic Health... Dec 2023Racial and ethnic disparities are commonplace in health care. Research often relies on sociodemographic information recorded in the electronic health record (EHR).... (Observational Study)
Observational Study
OBJECTIVE
Racial and ethnic disparities are commonplace in health care. Research often relies on sociodemographic information recorded in the electronic health record (EHR). Little evidence is available about the accuracy of EHR-recorded sociodemographic information, and none in pediatrics. Our objective was to determine the accuracy of EHR-recorded race and ethnicity compared to self-report.
METHODS
Patients/guardians enrolled in two prospective observational studies (10/2014-1/2019) provided self-reported sociodemographic information. Corresponding EHR information was abstracted. EHR information was compared to self-report, considered "gold standard." Agreement was evaluated with Cohen's kappa.
RESULTS
A total of 503 patients (42% female, median age 12.8 years) were identified. Self-reported race (N = 484) was 73% White, 16% Black or African American (AA), 4% Asian, 5% multiracial, and 2% other. Self-reported ethnicity (N = 410) was 9% Hispanic/Latino, and 88% non-Hispanic/Latino. Agreement between self-reported and EHR-recorded race was substantial (kappa = 0.77, 95% CI 0.72-0.83). Race was discordant among 10% (47/476). Hispanic/Latino ethnicity also had strong agreement (kappa = 0.77, 95% CI 0.65-0.89). Among those who self-reported Hispanic/Latino and reported race (N = 21), race was less accurately recorded in the EHR (kappa = 0.26, 95% CI 0-0.54). Race did not match among 43% with recorded race (9/21). Among self-reported racial and/or ethnic minorities, 13% (12/164) were misclassified in the EHR as non-Hispanic White.
CONCLUSIONS
We found race and ethnicity are often inaccurately recorded in the EHR for patients who self-identify as minorities, leading to under-representation of minorities in the EHR. Inaccurately recorded race and ethnicity has important implications for disparity research, and for informing health policy. Reliable processes are needed to incorporate self-reported race and ethnicity in the EHR at institutional and national levels.
Topics: Child; Female; Humans; Male; Electronic Health Records; Ethnicity; Hispanic or Latino; Minority Groups; Self Report; Black or African American; White; Racial Groups
PubMed: 36418736
DOI: 10.1007/s40615-022-01445-w -
Journal of Burn Care & Research :... Sep 2023Outcomes of burn survivors is a growing field of interest; however, there is little data comparing the outcomes of burn survivors by ethnicity. This study seeks to...
Outcomes of burn survivors is a growing field of interest; however, there is little data comparing the outcomes of burn survivors by ethnicity. This study seeks to identify any inequities in burn outcomes by racial and ethnic groups. A retrospective chart review of an ABA Certified burn center at a large urban safety net hospital identified adult inpatient admissions from 2015 to 2019. A total of 1142 patients were categorized by primary ethnicity: 142 black or African American, 72 Asian, 479 Hispanic or Latino, 90 white, 215 other, and 144 patients whose race or ethnicity was unrecorded. Multivariable analyses evaluated the relationship between race and ethnicity and outcomes. Covariate confounders were controlled by adjustment of demographic, social, and prehospital clinical factors to isolate differences that might not be explained by other factors. After controlling for covariates, black patients had 29% longer hospital stays (P = .043). Hispanic patients were more likely to be discharged to home or to hospice care (P = .005). Hispanic ethnicity was associated with a 44% decrease in the odds of discharge to acute care, inpatient rehabilitation, or a ward outside the burn unit (P = .022). Black and Hispanic patients had a higher relative chance of having publicly assisted insurance, versus private insurance, than their white counterparts (P = .041, P = .011 respectively). The causes of these inequities are indeterminate. They may stem from socioeconomic status not entirely accounted for, ethnic differences in comorbidity related to stressors, or inequity in health care delivery.
Topics: Adult; Humans; Burns; Ethnicity; Hispanic or Latino; Retrospective Studies; White; Black or African American; Asian; Racial Groups; Healthcare Disparities
PubMed: 36881674
DOI: 10.1093/jbcr/irad033 -
Social Neuroscience Jul 2012Williams syndrome (WS) is a genetic condition with a distinctive social phenotype characterized by excessive sociability accompanied by a relative proficiency in face...
Williams syndrome (WS) is a genetic condition with a distinctive social phenotype characterized by excessive sociability accompanied by a relative proficiency in face recognition, despite severe deficits in the visuospatial domain of cognition. This consistent phenotypic characteristic and the relative homogeneity of the WS genotype make WS a compelling human model for examining genotype-phenotype relations, especially with respect to social behavior. Following up on a recent report suggesting that individuals with WS do not show race bias and racial stereotyping, this study was designed to investigate the neural correlates of the perception of faces from different races, in individuals with WS as compared to typically developing (TD) controls. Caucasian WS and TD participants performed a gender identification task with own-race (White) and other-race (Black) faces while event-related potentials (ERPs) were recorded. In line with previous studies with TD participants, other-race faces elicited larger amplitude ERPs within the first 200 ms following the face onset, in WS and TD participants alike. These results suggest that, just like their TD counterparts, individuals with WS differentially processed faces of own-race versus other-race, at relatively early stages of processing, starting as early as 115 ms after the face onset. Overall, these results indicate that neural processing of faces in individuals with WS is moderated by race at early perceptual stages, calling for a reconsideration of the previous claim that they are uniquely insensitive to race.
Topics: Adult; Brain; Electroencephalography; Evoked Potentials; Face; Female; Humans; Male; Prejudice; Racial Groups; Recognition, Psychology; Visual Perception; Williams Syndrome; Young Adult
PubMed: 22022973
DOI: 10.1080/17470919.2011.628759 -
The Milbank Quarterly Sep 2020Policy Points Protective transgender-specific policies (including those related to experiences of discrimination, health insurance coverage, and changing legal...
State-Level Transgender-Specific Policies, Race/Ethnicity, and Use of Medical Gender Affirmation Services among Transgender and Other Gender-Diverse People in the United States.
UNLABELLED
Policy Points Protective transgender-specific policies (including those related to experiences of discrimination, health insurance coverage, and changing legal documents) are associated with increased access to medical gender affirmation services (hormone treatment, therapy/counseling) for transgender and other gender-diverse people. Restrictive transgender-specific policies are associated with less access to these services. The relationship between race/ethnicity and use of medical gender affirmation services varies across states and is context specific, indicating that race/ethnicity also plays a role in access to these types of care across states. Advocacy is needed to prevent or overturn restrictive policies and promote protective policies for transgender and other gender-diverse people, especially for people of color.
CONTEXT
In the 2010s, the number of federal, state, and local transgender-specific policies increased. Some of these policies advanced protections for transgender and other gender-diverse (TGGD) people, and others were restrictive. Little is known about the relationships between these policies and use of medical gender affirmation services (eg, hormone treatment, therapy/counseling), or about how these associations may vary among different racial and ethnic groups.
METHODS
Multilevel modeling was used to examine the associations between state-level transgender-specific policies and the use of medical gender affirmation services among TGGD people in the United States. Data are from the 2015 U.S. Trans Survey of nearly 28,000 TGGD people. The medical gender affirmation services examined in this study were hormone treatment and therapy/counseling. The state policies we analyzed addressed discrimination, health insurance coverage, and changing legal documents; these policies were measured individually and as a composite index. Race/ethnicity was included in the multilevel regression models as a random slope to determine whether the relationship between race/ethnicity and the use of medical gender affirmation services varied by state.
FINDINGS
Individual policies and the policy index were associated with both outcomes (use of therapy/counseling and hormone treatment services), indicating that protective policies were associated with increased care. Broad religious exemption laws and Medicaid policies that excluded transgender-specific care were both associated with less use of therapy/counseling, whereas transgender-care-inclusive Medicaid policies were associated with more use of therapy/counseling. Nondiscrimination protections that include gender identity were associated with increased use of hormone treatment services. The relationship between race/ethnicity and medical gender affirmation services varied across states.
CONCLUSIONS
State-level transgender-specific policies influence medical gender affirmation service use and seem to affect use by non-Hispanic white TGGD people and TGGD people of color differently. Advocacy is needed to repeal restrictive policies and promote protective policies in order to reduce health inequities among TGGD people, especially people of color.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ethnicity; Female; Health Policy; Health Services Accessibility; Humans; Insurance Coverage; Insurance, Health; Male; Middle Aged; Patient Acceptance of Health Care; Racial Groups; Sexual and Gender Minorities; State Government; Transgender Persons; United States; Young Adult
PubMed: 32808696
DOI: 10.1111/1468-0009.12467 -
Ethnicity & Health May 2023Existing scholarship has consistently demonstrated disparities in healthcare experience based on sexual identity. However, relatively little research has considered...
OBJECTIVES
Existing scholarship has consistently demonstrated disparities in healthcare experience based on sexual identity. However, relatively little research has considered intersections with race/ethnicity, despite that intersection with other characteristics may complicate healthcare experiences and satisfaction among sexual minorities. This study aims to address such a gap by examining healthcare satisfaction across the intersections of sexual and racial/ethnic identity.
DESIGN
Utilizing data on U.S. adults included in the 2013-2018 Behavioral Risk Factor Surveillance System (BRFSS) ( = 372,766), we investigate levels of satisfaction with care among a range of groups simultaneously embodying two identities.
RESULTS
Findings from ordered logistic regression models show that among adults who identify as heterosexual, the odds of reporting high satisfaction with care are lower among Blacks, Asians, and Native Americans. Among sexual minority adults, the likelihood of reporting high satisfaction with care is consistently lower among Native American gay and lesbian adults compared to gays and lesbians of other race/ethnicity or Native American and White heterosexuals, indicating heightened vulnerability to poorer healthcare experience among this multiple minority group.
CONCLUSION
While levels of satisfaction with care tend to be generally high across groups, future research should endeavor to investigate the driving factors that lower the odds of high healthcare satisfaction among those with intersecting minority identities.
Topics: Adult; Female; Humans; Male; Ethnicity; Heterosexuality; Sexual and Gender Minorities; Sexual Behavior; Racial Groups; United States; Patient Satisfaction; Behavioral Risk Factor Surveillance System; Logistic Models; Middle Aged; Aged
PubMed: 35803900
DOI: 10.1080/13557858.2022.2096207