Authors: Dame Idossa, Narjust Duma, Katerina Chekhovskiy...

The use of race and ethnicity in biomedical research has been a subject of debate for the past three decades. Initially the two major race categories were: White and Black, leaving other minorities uncounted or inappropriately misclassified. As the science of health disparities evolves, more sophisticated and detailed information has been added to large databases. Despite the addition of new racial classifications, including multi-racial denominations, the quality of the data is limited to the data collection process and other social misconceptions. Although race is viewed as an imposed or ascribed status, ethnicity is an achieved status, making it a more challenging variable to include in biomedical research. Ambiguity between race and ethnicity often exists, ultimately affecting the value of both variables. To better understand specific health outcomes or disparities of groups, it is necessary to collect subgroup-specific data. Cultural perceptions and practices, health experiences, and susceptibility to disease vary greatly among broad racial-ethnic groups and requires the collection of nuanced data to understand. Here, we provide an overview of the classification of race and ethnicity in the United States over time, the existing challenges in using race and ethnicity in biomedical research and future research directions.

Topics: Biomedical Research; Cultural Diversity; Data Collection; Ethnicity; Health Status Disparities; Humans; United States

PubMed: 30405301
DOI: 10.18865/ed.28.4.561

Randomized Controlled Trial

Authors: Lori Uscher-Pines, Kandice Kapinos, Molly Waymouth...

IMPORTANCE

There are substantial disparities in breastfeeding rates by race and ethnicity. Telelactation services that connect parents to lactation consultants via video are increasingly available and may reduce inequities in breastfeeding support; however, there is limited evidence on effectiveness.

OBJECTIVE

To assess the impact of video telelactation services on breastfeeding duration and exclusivity across a racially and ethnically diverse population of parents.

DESIGN, SETTING, AND PARTICIPANTS

This digital randomized clinical trial was conducted across 39 states. Eligible participants were aged 18 years or older, were in their third trimester of pregnancy with their first child, and intended to breastfeed. Participants were recruited through pregnancy apps from July 2021 to December 2022 and followed up through 24 weeks post partum. Analyses were completed from December 2023 to June 2024.

INTERVENTION

Pregnant individuals were randomized 1:1 to the treatment arm, which received access to a smartphone app with on-demand access to lactation consultants 24 hours a day via video visits, or to the control arm, which received an infant care e-book.

MAIN OUTCOMES AND MEASURES

Any breastfeeding and any infant formula use at 24 weeks post partum and time to breastfeeding cessation. The intention-to-treat analysis used regression models to estimate unadjusted effects and effects adjusted for baseline characteristics.

RESULTS

A total of 2108 participants were randomized, and 1911 were analyzed for primary outcomes. The mean (SD) age at the time of recruitment was 29.61 (5.37) years, and 707 participants (37.0%) had a household income of less than $55 000. In all, 611 participants (32.0%) identified as Black, 678 (35.5%) as Latinx, and 622 (32.5%) as races and/or ethnicities other than Black or Latinx. Among treatment arm participants, 466 (48.8%) used telelactation services. In intention-to-treat analyses, the proportion of all participants who reported any breastfeeding at 24 weeks was 674 (70.6%) in the treatment group and 639 (66.8%) in the control group (adjusted difference, 3.6 percentage points; 95% CI, -0.5 to 7.6 percentage points; P = .08), and the proportion with exclusive breastfeeding at 24 weeks was 447 (46.9%) in the treatment arm and 421 (44.1%) in the control arm (adjusted difference, 2.4 percentage points; 95% CI, -1.9 to 6.8 percentage points; P = .28). Differences were significant among Black participants. The proportion of Black participants who reported any breastfeeding at 24 weeks was 196 of 301 (65.1%) in the treatment arm and 178 of 310 (57.4%) in the control arm (adjusted difference, 7.5 percentage points; 95% CI, 0.2-14.8 percentage points; P = .045) and who reported breastfeeding exclusively at 24 weeks was 128 of 300 (42.7%) in the treatment arm and 105 of 310 (33.9%) in the control arm (adjusted difference, 9.2 percentage points; 95% CI, 1.4-16.9 percentage points; P = .02).

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, telelactation services had no significant effect on breastfeeding rates among participants overall, but significant improvements were found among Black individuals. The results suggest that telelactation services could be a component of a comprehensive strategy to reduce racial disparities in breastfeeding rates.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04856163.

Topics: Humans; Breast Feeding; Female; Adult; Pregnancy; Ethnicity; Telemedicine; Racial Groups

PubMed: 40014345
DOI: 10.1001/jamanetworkopen.2024.61958

Review

Authors: Robert S Sterling

BACKGROUND

Hip fracture is an international public health problem. Worldwide, approximately 1.5 million hip fractures occur per year, with roughly 340,000 in the United States in individuals older than 65 years. In 2050, there will be an estimated 3.9 million fractures worldwide, with more than 700,000 in the United States. However, whether there are disparities in morbidity, mortality, and function between men and women or between races/ethnicities is unclear.

QUESTIONS/PURPOSES

The purpose of this article is to review the gender and racial/ethnicity differences in hip fracture epidemiology, mortality, and function and to ask what more information is needed and how can it be attained.

METHODS

A PubMed literature review was performed and appropriate articles selected for inclusion in the review. WHERE ARE WE NOW?: Overall, men with hip fracture are younger, are less healthy, and have a higher postoperative mortality and morbidity. African American and Hispanics patients with hip fractures are younger than whites and have a higher incidence of fracture in men. Non-Hispanic black, Hispanic, and Asian race/ethnicity were all associated with higher odds of discharge home but a longer stay when discharged to rehabilitation. WHERE DO WE NEED TO GO?: Expanded knowledge of the influence of gender and race/ethnicity on hip fracture epidemiology, mortality, and outcomes is necessary. HOW DO WE GET THERE?: Additional focused research on gender and racial/ethnic differences in patients with hip fractures is needed. Improving database capture of race/ethnicity data will aid in population studies. Finally, journal editors should require authors to include gender and race/ethnicity data or explain the absence of this information.

Topics: Ethnicity; Female; Hip Fractures; Hip Joint; Humans; Male; Men; Minority Groups; Morbidity; Publishing; Recovery of Function; Sex Characteristics; Sex Factors; Survival Rate; Women

PubMed: 21161737
DOI: 10.1007/s11999-010-1736-3

Authors: Duleeka Knipe, Paul Moran, Laura D Howe...

BACKGROUND

Understanding of ethnic disparities in suicide in England and Wales is poor as ethnicity is not recorded on death certificates. Using linked data, we examined variations, by sex, in suicide rates in England and Wales by ethnicity and migrant and descendant status.

METHODS

Using the Office for National Statistics 2012-19 mortality data linked to the 2011 census from the Public Health Research Database, we calculated the age-standardised suicide rates by sex for each of the 18 self-identified ethnicity groups in England and Wales. We present rates by age, sex, and methods used for suicide by ethnic group. We estimated age-adjusted and sex-adjusted incidence rate ratios (IRRs) using Poisson regression models for each minority ethnic group compared with the majority population. We involved people with lived experience in the research.

FINDINGS

Overall, 31 644 suicide deaths occurred over the study period, including 3602 (11%) in people from minority ethnic backgrounds, with a mean age of death of 43·3 years (SD 17·0, range 13-96). Almost all minority ethnic groups had a lower rate of suicide than the White British majority, apart from individuals who identified as being from a Mixed heritage background or White Gypsy or Irish Travellers. In females who identified as Mixed White and Caribbean, the suicide IRR was 1·79 (95% CI 1·45-2·21) compared with the White British majority; in those who identified as White Gypsy or Irish Travellers, the IRR was 2·26 (1·42-3·58). Rates in males identifying as from these two groups and those identifying as White Irish were similar to the White British majority. Compared with the non-migrant population, migrants had a lower rate of suicide regardless of ethnicity, but in the descendant population, people from a Mixed ethnicity background had a higher risk of suicide than the White British majority.

INTERPRETATION

There are ethnic disparities in suicide mortality in England and Wales, but the reasons for this are unclear. The higher rate in previously overlooked minority ethnic groups warrants further attention.

FUNDING

Wellcome Trust.

Topics: Humans; Wales; England; Male; Female; Adult; Suicide; Middle Aged; Young Adult; Adolescent; Aged; Ethnicity; Cohort Studies; Aged, 80 and over

PubMed: 39025632
DOI: 10.1016/S2215-0366(24)00184-6

Review

Authors: Maryam Khan, Barbara I Nicholl, Peter Hanlon...

BACKGROUND

Ethnic variations in frailty are not fully understood. This systematic review examined ethnic differences in the prevalence, incidence and trajectories of frailty; associations between frailty and sociodemographic/lifestyle risk-factors; and health-related outcomes of frailty.

METHODS

We searched four electronic databases from 2000 to July 2023 using terms for ethnicity and frailty.

INCLUSION CRITERIA

observational studies assessing frailty in adults ≥ 18 years from community-based settings, including care homes; ethnicity defined by race, country of birth, language, ancestry, or culture. We supplemented searches with manual citation and reference list searches. Outcomes included prevalence, incidence, and transitions of frailty; factors associated with frailty; and health-related outcomes (e.g., mortality). Two reviewers independently screened all articles.

RESULTS

We included 82 studies, representing data from 13 countries plus two multi-national samples. Across the included countries, frailty prevalence was higher in minority groups compared to majority groups. Ethnic differences appear sensitive to methods used to measure frailty. Two United States-based studies found that ethnic differences were independent of sociodemographic differences such as income or education. Six studies from the United States or United Kingdom showed that Black and South-Asian people, respectively, had higher frailty incidence or more rapid frailty progression. Two studies showed that frailty was associated with mortality across ethnic groups but with some small differences in magnitude between groups.

CONCLUSION

Ethnic disparities in frailty prevalence persist across community-based settings in different countries and are not fully explained by known inequalities. Addressing these disparities will likely require careful frailty measurement and assessment; confronting structural inequalities; and tailoring interventions to the needs of minoritised populations.

Topics: Humans; Frailty; Prevalence; Incidence; Ethnicity; Risk Factors; Aged

PubMed: 40306389
DOI: 10.1016/j.arr.2025.102759

Authors: Tory M Taylor, John Hembling, Jane T Bertrand...

OBJECTIVES

To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes.

DESIGN

Data on 16,205 women aged 15-49 and 6822 men aged 15-59 from the 2008-2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only).

RESULTS

The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage.

CONCLUSIONS

The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.

Topics: Adolescent; Adult; Coitus; Ethnicity; Female; Guatemala; HIV Infections; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Indians, Central American; Male; Middle Aged; Sexual Partners; Unsafe Sex; Young Adult

PubMed: 24834462
DOI: 10.1080/13557858.2014.893562

Comparative Study Review

Authors: Katherine A Drake, Joshua M Galanter, Esteban González Burchard...

Asthma is a common but complex respiratory disease caused by the interaction of genetic and environmental factors. Significant racial and ethnic disparities in prevalence, mortality and drug response have been described. These disparities may be explained by racial and ethnic-specific variation in genetic, environmental, social and psychological risk factors. In addition, race, ethnicity and social class are important proxies for unmeasured factors that influence health outcomes. Herein, we review salient differences in the etiologies of asthma by race, ethnicity and social class, and argue for their continued use as variables in asthma research.

Topics: Animals; Asthma; Ethnicity; Genetic Predisposition to Disease; Humans; Racial Groups; Risk Factors; Social Class

PubMed: 18384258
DOI: 10.2217/14622416.9.4.453

Review

Authors: Malia N M Blue, Grant M Tinsley, Eric D Ryan...

Multi-compartment body-composition models that divide the body into its multiple constituents are the criterion method for measuring body fat percentage, fat mass, and fat-free mass. However, 2- and 3-compartment body-composition devices such as air displacement plethysmography (ADP), DXA, and bioelectrical impedance devices [bioelectrical impedance analysis (BIA)] are more commonly used. Accurate measures depend on several assumptions, including constant hydration, body proportion, fat-free body density, and population characteristics. Investigations evaluating body composition in racial and ethnic minorities have observed differences in the aforementioned components between cohorts. Consequently, for racial/ethnic minority populations, estimates of body composition may not be valid. The purpose of this review was to comprehensively examine the validity of common body-composition devices in multi-ethnic samples (samples including >1 race/ethnicity) and in African-American, Hispanic, Asian, and Native American populations. Based on the literature, DXA produces valid results in multi-ethnic samples and ADP is valid for Hispanic and African American males when utilizing race-specific equations. However, for DXA and ADP, there is a need for validity investigations that include larger, more racially diverse samples, specifically including Hispanic/Latinx, Asian, Native American adults, and African-American females. Technology has advanced significantly since initial validity studies were conducted; therefore, conclusions are based on outdated models and software. For BIA, body-composition measures may be valid in a multi-ethnic sample, but the literature demonstrates disparate results between races/ethnicities. For BIA and ADP, the majority of studies have utilized DXA or hydrostatic weighing as the criterion to determine validity; additional studies utilizing a multi-compartment model criterion are essential to evaluate accuracy. Validity studies evaluating more recent technology in larger, more racially/ethnically diverse samples may improve our ability to select the appropriate method to accurately assess body composition in each racial/ethnic population.

Topics: Absorptiometry, Photon; Adult; Body Composition; Electric Impedance; Ethnicity; Female; Humans; Male; Minority Groups

PubMed: 33684215
DOI: 10.1093/advances/nmab016

Meta-Analysis Review

Authors: Angela McGilloway, Ruth E Hall, Tennyson Lee...

BACKGROUND

Although psychoses and ethnicity are well researched, the importance of culture, race and ethnicity has been overlooked in Personality Disorders (PD) research. This study aimed to review the published literature on ethnic variations of prevalence, aetiology and treatment of PD.

METHOD

A systematic review of studies of PD and race, culture and ethnicity including a narrative synthesis of observational data and meta-analyses of prevalence data with tests for heterogeneity.

RESULTS

There were few studies with original data on personality disorder and ethnicity. Studies varied in their classification of ethnic group, and few studies defined a specific type of personality disorder. Overall, meta-analyses revealed significant differences in prevalence between black and white groups (OR 0.476, CIs 0.248 - 0.915, p = 0.026) but no differences between Asian or Hispanic groups compared with white groups. Meta-regression analyses found that heterogeneity was explained by some study characteristics: a lower prevalence of PD was reported among black compared with white patients in UK studies, studies using case-note diagnoses rather than structured diagnostic interviews, studies of borderline PD compared with the other PD, studies in secure and inpatient compared with community settings, and among subjects with co-morbid disorders compared to the rest. The evidence base on aetiology and treatment was small.

CONCLUSION

There is some evidence of ethnic variations in prevalence of personality disorder but methodological characteristics are likely to account for some of the variation. The findings may indicate neglect of PD diagnosis among ethnic groups, or a true lower prevalence amongst black patients. Further studies are required using more precise cultural and ethnic groups.

Topics: Black or African American; Ethnicity; Hispanic or Latino; Humans; Personality Disorders; Prevalence; Racial Groups; Socioeconomic Factors; White People

PubMed: 20459788
DOI: 10.1186/1471-244X-10-33

Review

Authors: Zeinab Majid, Carly Welch, Justine Davies...

Frailty is an important consequence of ageing, whereby frail patients are more likely to face adverse outcomes, such as disability and death. Risk of frailty increases in people with poor biological health, and has been shown in many ethnicities and countries. In economically developed countries, 10% of older adults are living with frailty. Ethnic minorities in the West face significant health inequalities. However, little is known about frailty prevalence and the nature of frailty in different ethnic groups. This has implications for healthcare planning and delivery, especially screening and the development of interventions. Global frailty prevalence is variable: low- to middle-income countries demonstrate higher rates of frailty than high-income countries, but available evidence is low. Little is known about the characteristics of these differences. However, female sex, lower economic status, lower education levels, and multimorbidity are identified risk factors. Ethnic minority migrants in economically developed countries demonstrate higher rates of frailty than white indigenous older people and are more likely to be frail when younger. Similar patterns are also seen in indigenous ethnic minority marginalised groups in economically developed countries such as the US, Australia and New Zealand, who have a higher prevalence of frailty than the majority white population. Frailty trajectories between ethnic minority migrants and white indigenous groups in high-income countries converge in the 'oldest old' age group, with little or no difference in prevalence. Frailty risk can be attenuated in migrants with improvements in integration, citizenship status, and access to healthcare. Ethnicity may play some role in frailty pathways, but, so far, the evidence suggests frailty is a manifestation of lifetime environmental exposure to adversity and risk accumulation.

Topics: Emigrants and Immigrants; Ethnicity; Frailty; Global Health; Humans; Minority Groups; Socioeconomic Factors

PubMed: 32747038
DOI: 10.1016/j.maturitas.2020.05.010