-
Journal of Racial and Ethnic Health... Dec 2023Individuals from Black and Hispanic backgrounds represent a minority of the overall US population, yet are the populations most affected by the disease of obesity and... (Review)
Review
A Systematic Review on Participant Diversity in Clinical Trials-Have We Made Progress for the Management of Obesity and Its Metabolic Sequelae in Diet, Drug, and Surgical Trials.
OBJECTIVE
Individuals from Black and Hispanic backgrounds represent a minority of the overall US population, yet are the populations most affected by the disease of obesity and its comorbid conditions. Black and Hispanic individuals remain underrepresented among participants in obesity clinical trials, despite the mandate by the National Institutes of Health (NIH) Revitalization Act of 1993. This systematic review evaluates the racial, ethnic, and gender diversity of clinical trials focused on obesity at a national level.
METHODS
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of clinicaltrials.gov, PubMed, Cochrane Central, and Web of Science was undertaken to locate phase 3 and phase 4 clinical trials on the topic of obesity that met associated inclusion/exclusion criteria. Ultimately, 18 studies were included for review.
RESULTS
White non-Hispanic individuals represented the majority of clinical trial participants, as did females. No study classified participants by gender identity. Reporting of race/ethnicity was not uniform, with noted variability among racial/ethnic subgroups.
CONCLUSIONS
Our findings suggest that disparities remain in the diverse racial, ethnic, and gender representation of participants engaged in clinical trials on obesity relative to the prevalence of obesity in underrepresented populations. Commitment to inclusive and intentional recruiting practices is needed to increase the representation of underrepresented groups, thus increasing the generalizability of future research.
Topics: Humans; Male; Female; Gender Identity; Ethnicity; Obesity; Diet; White
PubMed: 36536164
DOI: 10.1007/s40615-022-01487-0 -
Fertility and Sterility Mar 2023There is emergent scientific literature examining the disparities in reproductive care of women in the United States. Reproduction is a basic human right and there are... (Review)
Review
There is emergent scientific literature examining the disparities in reproductive care of women in the United States. Reproduction is a basic human right and there are unique challenges that racial and ethnic minorities face in accessing fertility care and assisted reproductive technology. The identification of these disparities can aid in identifying areas for interventions to improve and resolve, the inequities that exist in providing care for minority populations. A literature search was performed using PubMed to identify articles with data specific to racial and ethnic differences in study populations as it related to infertility, access to care, and treatment outcomes. The following review and collection of articles provide a comprehensive overview of the disparities that exist, the factors that contribute to these disparities, and recommendations for how providers and health care systems may begin to resolve the gaps in equitable care.
Topics: Humans; Female; United States; Ethnicity; Racial Groups; Minority Groups; Reproduction; Delivery of Health Care; Healthcare Disparities
PubMed: 36682687
DOI: 10.1016/j.fertnstert.2023.01.023 -
BMJ (Clinical Research Ed.) Mar 2011To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts.
STUDY SELECTION
The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n = 23,742) indicated candidates of "non-white" ethnicity underperformed compared with white candidates (Cohen's d = -0.42, 95% confidence interval -0.50 to -0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses.
CONCLUSION
Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors.
Topics: Education, Medical, Graduate; Education, Medical, Undergraduate; Educational Measurement; Educational Status; Humans; Prospective Studies; Racial Groups; Retrospective Studies; Students, Medical; United Kingdom
PubMed: 21385802
DOI: 10.1136/bmj.d901 -
Cancer Medicine Sep 2023Childhood cancer survivors (CCS) experience many long-term health problems that can be mitigated with recommended survivorship care. However, many CCS do not have access... (Review)
Review
BACKGROUND
Childhood cancer survivors (CCS) experience many long-term health problems that can be mitigated with recommended survivorship care. However, many CCS do not have access to survivorship care nor receive recommended survivorship care. We reviewed the empirical evidence of disparities in survivorship care for CCS.
METHODS
This systematic review searched PubMed, CINAHL, and PsycINFO for studies on survivorship care for CCS (PROSPERO: CRD42021227965) and abstracted the reported presence or absence of disparities in care. We screened 7945 citations, and of those, we reviewed 2760 publications at full text.
RESULTS
A total of 22 studies reported in 61 publications met inclusion criteria. Potential disparities by cancer treatment (N = 14), diagnosis (N = 13), sex (N = 13), and current age (N = 13) were frequently studied. There was high quality of evidence (QOE) of survivorship care disparities associated with non-White race, Hispanic ethnicity, and being uninsured. Moderate QOE demonstrated disparities among CCS who were unemployed and older. Lower QOE was found for disparities based on cancer diagnosis, cancer treatment, age at diagnosis, time since diagnosis, sex, insurance type, income, educational attainment, and geographic area.
CONCLUSIONS
We found strong empirical evidence of disparities in survivorship care for CCS associated with race, ethnicity, and insurance status. Multiple other disparate groups, such as those by employment, income, insurance type, education, cancer diagnosis, age at diagnosis, time since diagnosis, cancer treatment, geographic area, sex, and self-identified gender warrant further investigation. Prospective, multilevel research is needed to examine the role of other patient characteristics as potential disparities hindering adequate survivorship care in CCS.
Topics: Child; Humans; Cancer Survivors; Prospective Studies; Ethnicity; Hispanic or Latino; Income; Neoplasms; Healthcare Disparities
PubMed: 37551113
DOI: 10.1002/cam4.6426 -
BMC Public Health Nov 2022Orang Asli, the indigenous people of Peninsular Malaysia, is a minority population and placed behind in terms of socioeconomy, education and health. The Malaysian...
Orang Asli, the indigenous people of Peninsular Malaysia, is a minority population and placed behind in terms of socioeconomy, education and health. The Malaysian government has supported Orang Asli since the second Malaysia Plan in the 1970s, resulting in changes in their living standard, access to health, education and occupation. Hence, this review aims to assess the recent prevalence of diseases among Orang Asli in Peninsular Malaysia. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) review protocol guided this systematic review. The research question was formulated based on Population, Interest, Comparison and Outcome (PICO). The selected databases include Web of Science, Scopus, Ovid and EBSCOhost. The process of identification, screening and inclusion identified 33 articles. The mixed methods appraisal tool (MMAT) was then used to rank the quality of the articles. Selangor is the most frequent state involved in this review (12 studies), followed by Perak (10 studies), Pahang (10 studies) and Kedah (one study). We categorised into four categories of diseases, namely neglected tropical disease (n = 20), non-communicable disease (n = 6), nutritional status (n = 5), and hepatic disease (n = 2). The prevalence of diseases among Orang Asli is higher than in the general population, especially for soil-transmitted helminth (STH) and malnutrition. There is increasing research on non-communicable diseases due to an increasing trend in the socioeconomic status and lifestyle of the Orang Asli. Government agencies and private organisations must work together to empower Orang Asli with a healthy lifestyle, improve their socioeconomic status, and enhance food security, all of which will improve Orang Asli's health and reduce the prevalence of diseases.
Topics: Animals; Humans; Malaysia; Ethnicity; Socioeconomic Factors; Helminths; Population Groups
PubMed: 36384509
DOI: 10.1186/s12889-022-14449-2 -
American Journal of Public Health Mar 2013To investigate the possibility of a Hispanic mortality advantage, we conducted a systematic review and meta-analysis of the published longitudinal literature reporting... (Meta-Analysis)
Meta-Analysis Review
To investigate the possibility of a Hispanic mortality advantage, we conducted a systematic review and meta-analysis of the published longitudinal literature reporting Hispanic individuals' mortality from any cause compared with any other race/ethnicity. We searched MEDLINE, PubMed, EMBASE, HealthSTAR, and PsycINFO for published literature from January 1990 to July 2010. Across 58 studies (4 615 747 participants), Hispanic populations had a 17.5% lower risk of mortality compared with other racial groups (odds ratio = 0.825; P < .001; 95% confidence interval = 0.75, 0.91). The difference in mortality risk was greater among older populations and varied by preexisting health conditions, with effects apparent for initially healthy samples and those with cardiovascular diseases. The results also differed by racial group: Hispanics had lower overall risk of mortality than did non-Hispanic Whites and non-Hispanic Blacks, but overall higher risk of mortality than did Asian Americans. These findings provided strong evidence of a Hispanic mortality advantage, with implications for conceptualizing and addressing racial/ethnic health disparities.
Topics: Hispanic or Latino; Humans; Longitudinal Studies; Mortality; Racial Groups; United States
PubMed: 23327278
DOI: 10.2105/AJPH.2012.301103 -
Medicine May 2021Hypertension (HTN) has been considered as a health concern in developing countries. And Hui is a minority group with a large population in China. Its genetic background,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hypertension (HTN) has been considered as a health concern in developing countries. And Hui is a minority group with a large population in China. Its genetic background, inadequate access to health services, eating habits, religious belief, ethnic customs, and other factors differ from that of other ethnic groups, which may influence the prevalence of HTN. However, there is no current meta-analysis on the prevalence and risk factors of HTN among Hui population. Thus we conducted a systematic review aiming to estimate the pooled prevalence and risk factors of HTN among Hui population.
METHODS
PubMed, The Cochrane library, Web of science, CINAHL Complete, Weipu Database (VIP), China Knowledge Resource Integrated Database (CNKI), Wanfang Database, and SinoMed were systematically searched from inception to February 28, 2020 with publication language restricted to English and Chinese. We included cross-sectional, case-control, or cohort studies that focused on prevalence and risk factors of HTN among Hui population. Two investigators independently assessed the risk of bias of the studies included in the review using tools developed by JBI. Meta-analysis was conducted using Stata 12.0 software package.
RESULTS
Twenty-three studies were identified with a total of 30,565 study participants. The overall pooled prevalence of HTN was 28% (95% confidence interval [CI]: 24%-32%, I2 = 98.8%, P < .001). Stratified by gender, the pooled prevalence of HTN in Hui was 26% (95%CI: 20%-33%, I2 = 97.6%, P < .001) for males and 30% (95%CI: 23%-37%, I2 = 98.3%, P < .001) for females. Pooled prevalence of HTN in Hui was 2% (95%CI: 2%-6%, I2 = 70.6%, P = .065), 10% (95%CI: 3%-17%, I2 = 83.7%, P < .001), 22% (95%CI: 12%-32%, I2 = 87.9%, P < .001), 37% (95%CI: 20%-53%, I2 = 94.0%, P < .001), 39% (95%CI: 24%-54%, I2 = 97.7%, P < .001) and 42% (95%CI: 29%-56%, I2 = 95.6%, P < .001) for those aged 18 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70 years, respectively. Pooled prevalence of HTN in Hui was 22% (95%CI: 14%-29%, I2 = 97.9%, P < .001) in urban areas and 23% (95%CI: 16%-30%, I2 = 95.8%, P < .001) in rural areas. Daily salt intake (odd ratio [OR] = 3.94, 95%CI: 3.03-5.13, I2 = 90.2%, P < 001), family history (OR = 3.50, 95%CI: 2.60-4.71, I2 = 95.3%, P < .001), smoking (OR = 1.84, 95%CI: 1.61-2.09, I2 = 59.6%, P < .001), drinking (OR = 1.74, 95%CI: 1.26-2.39, I2 = 95.3%, P = .001), weekly meat intake (OR = 1.92, 95%CI: 1.04-3.54, I2 = 96.5%, P = .036), body mass index (OR = 2.20, 95%CI: 1.81-2.66, I2 = 91.3%, P < .001), and areas (OR = 1.29, 95%CI: 1.10-1.51, I2 = 81.5%, P = .001) were risk factors of HTN in Hui, while physical exercise (OR = 0.76, 95%CI: 0.66-0.88, I2 = 62.7%, P < .001) was protective factor.
CONCLUSIONS
The pooled prevalence of HTN among Hui people was 28%, daily salt intake, family history, drinking, smoking, weekly meat intake, body mass index, areas, and physical exercise were all risk factors for HTN among Hui population. Early screening and treatment of HTN among Hui population should be given due attention.
Topics: Alcohol Drinking; Asian People; Body Mass Index; China; Feeding Behavior; Humans; Hypertension; Meat; Medical History Taking; Minority Groups; Prevalence; Risk Factors; Smoking; Sodium Chloride, Dietary
PubMed: 33950917
DOI: 10.1097/MD.0000000000025192 -
International Journal of Environmental... Dec 2017Chinese are a fast-growing immigrant population group in several parts of the world (e.g., Australia, Canada, Europe, Southeast Asia, United States). Research evidence... (Review)
Review
Chinese are a fast-growing immigrant population group in several parts of the world (e.g., Australia, Canada, Europe, Southeast Asia, United States). Research evidence suggests that compared to non-Hispanic whites, individuals of Asian-origin including Chinese are at higher risk of developing cardiovascular disease and type 2 diabetes at a lower body mass index (BMI). These risks may be possibly due to genetic differences in body composition and metabolic responses. Despite the increasing numbers of Chinese children growing up in immigrant families and the increasing prevalence of obesity among Chinese, little research has been focused on children of Chinese immigrant families. This integrative review synthesizes the evidence on infant feeding beliefs, attitudes, knowledge and practices of Chinese immigrant mothers; highlights limitations of available research; and offers suggestions for future research. Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we searched four electronic academic/research databases (CINAHL, Medline, PsycINFO, and PubMed) to identify peer-reviewed, full-text papers published in English between January 2000 and September 2017. Only studies with mothers 18+ years old of normally developing infants were included. Of the 797 citations identified, 15 full-text papers were retrieved and 11 studies (8 cross-sectional studies, 3 qualitative studies) met the inclusion criteria and were included in this review. Reviewed studies revealed high initiation rates of breastfeeding, but sharp declines in breastfeeding rates by six months of age. In addition, reviewed studies revealed that the concomitantly use of breast milk and formula, and the early introduction of solid foods were common. Finally, reviewed studies identified several familial and socio-cultural influences on infant feeding beliefs and practices that may increase risk of overweight and obesity during infancy and early childhood among Chinese children of immigrant families. Nonetheless, as only 11 studies were identified and because the majority of studies ( = 8) were conducted in Australia, additional research including longitudinal studies, and studies conducted in countries with large Chinese immigrant population are needed to further identify and understand influences on Chinese immigrant mothers' beliefs, attitudes, and practices related to infant feeding that may increase risk of child overweight and obesity. This information is needed to develop interventions tailored to the beliefs and needs of this fast-growing immigrant group and aimed at promoting healthy infant feeding practices to prevent childhood overweight and obesity.
Topics: Asian People; Breast Feeding; Emigrants and Immigrants; Female; Health Knowledge, Attitudes, Practice; Humans; Infant; Infant Formula; Mothers
PubMed: 29295487
DOI: 10.3390/ijerph15010021 -
The Lancet. Global Health Jan 2018There is a dearth of accurate information about health outcomes and health service coverage among ethnic minorities in China. We assessed maternal and child health (MCH)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is a dearth of accurate information about health outcomes and health service coverage among ethnic minorities in China. We assessed maternal and child health (MCH) outcomes and service coverage among ethnic minorities compared with Han populations in western China.
METHODS
We did a systematic review searching English (Embase, MEDLINE, Web of Science) and Chinese (China National Knowledge Infrastructure [CNKI], VIP, Wanfang) databases for population-based studies comparing MCH indicators between ethnic minorities between Jan 1, 1990, and Nov 9, 2016, in any language. For studies making individual comparisons we used the odds ratio (OR) and corresponding 95% CIs as the primary measure to assess the association between MCH indicators and ethnicity. We used a random-effects model to pool odds ratios.
FINDINGS
We included 29 Chinese and 16 English language studies, providing 31 individual comparisons and 15 ecological comparisons. Ethnic minority women had lower odds of antenatal care use (pooled crude OR 0·60 [95% CI 0·48-0·75]) and birth in health facilities (0·50 [0·39-0·64]) than did Han women; and their children had higher odds of mortality (2·02 [1·23-3·32]) and lower immunisation (0·34 [0·24-0·47]) than did Han children. After taking account of the potential confounding effects of socioeconomic factors, ethnic minority women were less likely to use antenatal care (pooled adjusted OR 0·54 [0·42-0·71]) or to immunise their children (0·57 [0·44-0·74]) compared with Han women.
INTERPRETATION
China has a wealth of primary data that could further our understanding of why ethnic minority populations are lagging behind. As MCH outcomes continue to improve nationally, ethnic minorities will take a greater share of the overall burden of adverse outcomes, requiring strategic investments to address the specific challenges faced by people living in remote areas.
FUNDING
China Medical Board.
Topics: Child; Child Health; China; Ethnicity; Female; Humans; Maternal Health; Maternal-Child Health Services; Minority Groups; Pregnancy
PubMed: 29153766
DOI: 10.1016/S2214-109X(17)30445-X -
The Cochrane Database of Systematic... Dec 2010Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews... (Review)
Review
BACKGROUND
Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews to consider effects on health equity is cited by decision-makers as a limitation to their ability to inform policy and program decisions.
OBJECTIVES
To systematically review methods to assess effects on health equity in systematic reviews of effectiveness.
SEARCH STRATEGY
We searched the following databases up to July 2 2010: MEDLINE, PsychINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Index to Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on October 7 2010.
SELECTION CRITERIA
We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities.
DATA COLLECTION AND ANALYSIS
Data were extracted using a pre-tested form by two independent reviewers. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.
MAIN RESULTS
Thirty-four methodological studies were included. The methods used by these included studies were: 1) Targeted approaches (n=22); 2) gap approaches (n=12) and gradient approach (n=1). Gender or sex was assessed in eight out of 34 studies, socioeconomic status in ten studies, race/ethnicity in seven studies, age in seven studies, low and middle income countries in 14 studies, and two studies assessed multiple factors across health inequity may exist.Only three studies provided a definition of health equity. Four methodological approaches to assessing effects on health equity were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (all 34 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (12/34 studies); 3) analytic approaches (10/34 studies); and 4) applicability assessment (11/34 studies). Both analytic and applicability approaches were not reported transparently nor in sufficient detail to judge their credibility.
AUTHORS' CONCLUSIONS
There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to assess and report effects on health equity in systematic reviews.
Topics: Age Factors; Developing Countries; Ethnology; Health Status Disparities; Humans; Racial Groups; Research Design; Review Literature as Topic; Sex Factors; Socioeconomic Factors
PubMed: 21154402
DOI: 10.1002/14651858.MR000028.pub2