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Ethnicity & Disease 2018The 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...
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 -
Gender and race/ethnicity differences in hip fracture incidence, morbidity, mortality, and function.Clinical Orthopaedics and Related... Jul 2011Hip 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... (Review)
Review
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 -
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 -
Advances in Nutrition (Bethesda, Md.) Oct 2021Multi-compartment body-composition models that divide the body into its multiple constituents are the criterion method for measuring body fat percentage, fat mass, and... (Review)
Review
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 -
Pharmacogenomics Apr 2008Asthma is a common but complex respiratory disease caused by the interaction of genetic and environmental factors. Significant racial and ethnic disparities in... (Comparative Study)
Comparative Study Review
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 -
Journal of Racial and Ethnic Health... Aug 2020While disparities in depressive symptoms by race/ethnicity and gender have been documented, left unclear is how such status characteristics intersect to influence mental... (Comparative Study)
Comparative Study
While disparities in depressive symptoms by race/ethnicity and gender have been documented, left unclear is how such status characteristics intersect to influence mental health, particularly across early life and among a diverse set of population subgroups. This study investigates how intra- and inter-individual trends in depressive symptoms unfold across a 30-year span (ages 12-42) and are structured by the intersection of race/ethnicity and gender among White, Black, Hispanic, and Asian American young adults (N = 18,566). Analyses use data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents who have been followed through their fourth decade of life. We draw on Waves I-IV and a representative subsample of the brand new Wave V data. Growth curve models indicated depressive symptoms decreased across adolescence and young adulthood before increasing in the early 30s. Racial/ethnic minorities reported more depressive symptoms than Whites. Women reported more depressive symptoms than men and experienced especially steep increases in their late 30s. Racial/ethnic-gender disparities remained stable with age, except for Hispanic-White disparities among women and Asian American-White disparities among men, which narrowed with age. Overall, findings demonstrate dynamic inequalities across a longer period of the life span than was previously known, as well as heterogeneity in trajectories of poor mental health within and between racial/ethnic-gender groups. Results also suggest that Black and Asian American women experience the highest mental health risks and that interventions for reducing disparities in depressive symptoms should focus on adults in their late 20s/early 30s, particularly women of color.
Topics: Adolescent; Adult; Black or African American; Cohort Studies; Depression; Ethnicity; Female; Health Status Disparities; Hispanic or Latino; Humans; Longitudinal Studies; Male; Race Factors; Sex Factors; Socioeconomic Factors; Time Factors; United States; Young Adult
PubMed: 31997286
DOI: 10.1007/s40615-019-00692-8 -
Social Psychiatry and Psychiatric... May 2016There is substantial evidence to suggest that Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act (MHA). We examined... (Comparative Study)
Comparative Study
PURPOSE
There is substantial evidence to suggest that Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act (MHA). We examined ethnic differences in patients assessed for detention and explored the effect of ethnicity after controlling for confounders.
METHODS
A prospective study of all MHA assessments conducted in 1 year (April 2009-March 2010) within Birmingham and Solihull Mental Health Foundation Trust, UK. Proportion of assessments and detentions within denominator population of service users and regional populations were calculated. Multiple regression analysis was conducted to determine which variables were associated with the outcome of MHA assessment and the role of ethnicity.
RESULTS
Of the 1115 assessments, 709 led to detentions (63.58 %). BME ethnic groups were statistically more likely to be assessed and detained under the MHA as compared to Whites, both in the service user and the ethnic population estimates in Birmingham, UK. MHA detention was predicted by having a serious mental illness, the presence of risk, older age and living alone. Ethnicity was not associated with detention under the MHA with age, diagnosis, risk and level of social support accounted for.
CONCLUSION
The BME 'disproportionality' in detention rates seems to be due to higher rates of mental illness, greater risk and poorer levels of social support rather than ethnicity per se.
Topics: Adult; Black People; Commitment of Mentally Ill; Cross-Sectional Studies; England; Ethnicity; Female; Humans; Male; Mental Disorders; Middle Aged; Minority Groups; Prospective Studies; Racism; Risk Assessment; White People; Young Adult
PubMed: 26886264
DOI: 10.1007/s00127-016-1181-z -
Clinical Biochemistry Jan 2023Age and ethnicity are known to influence serum vitamin B (B) concentration, yet universal reference intervals (RIs) are typically applied by laboratories. Both lower and...
BACKGROUND
Age and ethnicity are known to influence serum vitamin B (B) concentration, yet universal reference intervals (RIs) are typically applied by laboratories. Both lower and upper RI limits for B are clinically relevant. Low values suggest deficiency leading to anemia and/or neurological impairment, while high values are not always an innocuous consequence of high B intake but are associated with some cancers, autoimmune, liver, and renal diseases. This work aimed to establish age- and ethnicity-related RIs for B using a modified indirect method based on Hoffmann's approach.
METHODS
A total of 72,091 anonymized B results (Jan 2018-Nov 2019) were analyzed from an ethnically-diverse South-East London general practice patient population. Patients belonged to five ethnic groups: Asian, Black, White, Mixed, or Other. Multiple records for the same patient and results with missing ethnicity were excluded from the analysis of adult RIs. B analyses were performed using ARCHITECT® (Abbott Diagnostics).
RESULTS
B was significantly higher in Black compared with Asian and White adults. There were no differences in B between Asian and White adults. Children (all ethnicities) between 2 and 5 years old had the highest B. Because of the small number of children (up to the age of 13) in each ethnic-related age category, all ethnic groups were combined to obtain age-related RIs. The children's RIs ranged from 159 to 1025 pmol/L for 0-1-year-olds to 276-1102 pmol/L for 2-5-year-olds. The RIs for Black and White/Asian people >13 years of age were 166-805 pmol/L and 134-511 pmol/L respectively.
CONCLUSIONS
The application of age- and ethnicity-appropriate RIs into diagnostic practice will provide a more accurate evaluation of B status when using the B test alone or in combination with other markers.
Topics: Adult; Child; Humans; Child, Preschool; Vitamin B 12; Ethnicity; Vitamin B 12 Deficiency; Biomarkers; Vitamins; Reference Values
PubMed: 36261053
DOI: 10.1016/j.clinbiochem.2022.10.007 -
Ethnicity & Health 2015To 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...
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 -
Maturitas Sep 2020Frailty 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... (Review)
Review
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