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American Journal of Preventive Medicine Feb 2020Infant mortality rates are higher in nonmetropolitan areas versus large metropolitan areas. Variation by race/ethnicity and cause of death has not been assessed....
INTRODUCTION
Infant mortality rates are higher in nonmetropolitan areas versus large metropolitan areas. Variation by race/ethnicity and cause of death has not been assessed. Urban-rural infant mortality rate differences were quantified by race/ethnicity and cause of death.
METHODS
National Vital Statistics System linked birth/infant death data (2014-2016) were analyzed in 2019 by 3 urban-rural county classifications: large metropolitan, medium/small metropolitan, and nonmetropolitan. Excess infant mortality rates (rate differences) by urban-rural classification were calculated relative to large metropolitan areas overall and for each racial/ethnic group. The number of excess deaths, population attributable fraction, and proportion of excess deaths attributable to underlying causes of death was calculated.
RESULTS
Nonmetropolitan areas had the highest excess infant mortality rate overall. Excess infant mortality rates were substantially lower for Hispanic infants than other races/ethnicities. Overall, 7.4% of infant deaths would be prevented if all areas had the infant mortality rate of large metropolitan areas. With more than half of births occurring outside of large metropolitan areas, the population attributable fraction was highest for American Indian/Alaska Natives (20.3%) and whites, non-Hispanic (14.3%). Excess infant mortality rates in both nonmetropolitan and medium/small metropolitan areas were primarily attributable to sudden unexpected infant deaths (42.3% and 31.9%) and congenital anomalies (30.1% and 26.8%). This pattern was consistent for all racial/ethnic groups except black, non-Hispanic infants, for whom preterm-related and sudden unexpected infant deaths accounted for the largest share of excess infant mortality rates.
CONCLUSIONS
Infant mortality increases with rurality, and excess infant mortality rates are predominantly attributable to sudden unexpected infant deaths and congenital anomalies, with differences by race/ethnicity regarding magnitude and cause of death.
Topics: Black or African American; Cause of Death; Ethnicity; Female; Humans; Indians, North American; Infant; Infant Mortality; Infant, Newborn; Male; Racial Groups; Rural Population; United States; Urban Population; Vital Statistics; White People
PubMed: 31735480
DOI: 10.1016/j.amepre.2019.09.010 -
JAMA Dec 2019The prevalence of diabetes among Hispanic and Asian American subpopulations in the United States is unknown.
IMPORTANCE
The prevalence of diabetes among Hispanic and Asian American subpopulations in the United States is unknown.
OBJECTIVE
To estimate racial/ethnic differences in the prevalence of diabetes among US adults 20 years or older by major race/ethnicity groups and selected Hispanic and non-Hispanic Asian subpopulations.
DESIGN, SETTING, AND PARTICIPANTS
National Health and Nutrition Examination Surveys, 2011-2016, cross-sectional samples representing the noninstitutionalized, civilian, US population. The sample included adults 20 years or older who had self-reported diagnosed diabetes during the interview or measurements of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and 2-hour plasma glucose (2hPG).
EXPOSURES
Race/ethnicity groups: non-Hispanic white, non-Hispanic black, Hispanic and Hispanic subgroups (Mexican, Puerto Rican, Cuban/Dominican, Central American, and South American), non-Hispanic Asian and non-Hispanic Asian subgroups (East, South, and Southeast Asian), and non-Hispanic other.
MAIN OUTCOMES AND MEASURES
Diagnosed diabetes was based on self-reported prior diagnosis. Undiagnosed diabetes was defined as HbA1c 6.5% or greater, FPG 126 mg/dL or greater, or 2hPG 200 mg/dL or greater in participants without diagnosed diabetes. Total diabetes was defined as diagnosed or undiagnosed diabetes.
RESULTS
The study sample included 7575 US adults (mean age, 47.5 years; 52% women; 2866 [65%] non-Hispanic white, 1636 [11%] non-Hispanic black, 1952 [15%] Hispanic, 909 [6%] non-Hispanic Asian, and 212 [3%] non-Hispanic other). A total of 2266 individuals had diagnosed diabetes; 377 had undiagnosed diabetes. Weighted age- and sex-adjusted prevalence of total diabetes was 12.1% (95% CI, 11.0%-13.4%) for non-Hispanic white, 20.4% (95% CI, 18.8%-22.1%) for non-Hispanic black, 22.1% (95% CI, 19.6%-24.7%) for Hispanic, and 19.1% (95% CI, 16.0%-22.1%) for non-Hispanic Asian adults (overall P < .001). Among Hispanic adults, the prevalence of total diabetes was 24.6% (95% CI, 21.6%-27.6%) for Mexican, 21.7% (95% CI, 14.6%-28.8%) for Puerto Rican, 20.5% (95% CI, 13.7%-27.3%) for Cuban/Dominican, 19.3% (95% CI, 12.4%-26.1%) for Central American, and 12.3% (95% CI, 8.5%-16.2%) for South American subgroups (overall P < .001). Among non-Hispanic Asian adults, the prevalence of total diabetes was 14.0% (95% CI, 9.5%-18.4%) for East Asian, 23.3% (95% CI, 15.6%-30.9%) for South Asian, and 22.4% (95% CI, 15.9%-28.9%) for Southeast Asian subgroups (overall P = .02). The prevalence of undiagnosed diabetes was 3.9% (95% CI, 3.0%-4.8%) for non-Hispanic white, 5.2% (95% CI, 3.9%-6.4%) for non-Hispanic black, 7.5% (95% CI, 5.9%-9.1%) for Hispanic, and 7.5% (95% CI, 4.9%-10.0%) for non-Hispanic Asian adults (overall P < .001).
CONCLUSIONS AND RELEVANCE
In this nationally representative survey of US adults from 2011 to 2016, the prevalence of diabetes and undiagnosed diabetes varied by race/ethnicity and among subgroups identified within the Hispanic and non-Hispanic Asian populations.
Topics: Adult; Asian; Cross-Sectional Studies; Diabetes Mellitus; Ethnicity; Female; Hispanic or Latino; Humans; Male; Nutrition Surveys; Prevalence; Racial Groups; Socioeconomic Factors; United States
PubMed: 31860047
DOI: 10.1001/jama.2019.19365 -
The Oncologist Jun 2021Asian Americans are the only racial/ethnic group in the U.S. for whom cancer is the leading cause of death in men and women, unlike heart disease for all other groups.... (Review)
Review
Asian Americans are the only racial/ethnic group in the U.S. for whom cancer is the leading cause of death in men and women, unlike heart disease for all other groups. Asian Americans face a confluence of cancer risks, with high rates of cancers endemic to their countries of origin due to infectious and cultural reasons, as well as increasing rates of "Western" cancers that are due in part to assimilation to the American diet and lifestyle. Despite the clear mortality risk, Asian Americans are screened for cancers at lower rates than the majority of Americans. Solutions to eliminate the disparity in cancer care are complicated by language and cultural concerns of this very heterogeneous group. This review addresses the disparities in cancer screening, the historical causes, the potential contribution of racism, the importance of cultural perceptions of health care, and potential strategies to address a very complicated problem. Noting that the health care disparities faced by Asian Americans may be less conspicuous than the structural racism that has inflicted significant damage to the health of Black Americans over more than four centuries, this review is meant to raise awareness and to compel the medical establishment to recognize the urgent need to eliminate health disparities for all. IMPLICATIONS FOR PRACTICE: Cancer is the leading cause of death in Asian Americans, who face cancers endemic to their native countries, perhaps because of infectious and cultural factors, as well as those faced by all Americans, perhaps because of "Westernization" in terms of diet and lifestyle. Despite the mortality rates, Asian Americans have less cancer screening than other Americans. This review highlights the need to educate Asian Americans to improve cancer literacy and health care providers to understand the important cancer risks of the fastest-growing racial/ethnic group in the U.S. Eliminating disparities is critical to achieving an equitable society for all Americans.
Topics: Black or African American; Asian; Female; Health Services Accessibility; Healthcare Disparities; Hispanic or Latino; Humans; Male; Neoplasms; Racial Groups; United States
PubMed: 33683795
DOI: 10.1002/onco.13748 -
JAMA Jul 2023Evidence suggests that maternal mortality has been increasing in the US. Comprehensive estimates do not exist. Long-term trends in maternal mortality ratios (MMRs) for... (Observational Study)
Observational Study
IMPORTANCE
Evidence suggests that maternal mortality has been increasing in the US. Comprehensive estimates do not exist. Long-term trends in maternal mortality ratios (MMRs) for all states by racial and ethnic groups were estimated.
OBJECTIVE
To quantify trends in MMRs (maternal deaths per 100 000 live births) by state for 5 mutually exclusive racial and ethnic groups using a bayesian extension of the generalized linear model network.
DESIGN, SETTING, AND PARTICIPANTS
Observational study using vital registration and census data from 1999 to 2019 in the US. Pregnant or recently pregnant individuals aged 10 to 54 years were included.
MAIN OUTCOMES AND MEASURES
MMRs.
RESULTS
In 2019, MMRs in most states were higher among American Indian and Alaska Native and Black populations than among Asian, Native Hawaiian, or Other Pacific Islander; Hispanic; and White populations. Between 1999 and 2019, observed median state MMRs increased from 14.0 (IQR, 5.7-23.9) to 49.2 (IQR, 14.4-88.0) among the American Indian and Alaska Native population, 26.7 (IQR, 18.3-32.9) to 55.4 (IQR, 31.6-74.5) among the Black population, 9.6 (IQR, 5.7-12.6) to 20.9 (IQR, 12.1-32.8) among the Asian, Native Hawaiian, or Other Pacific Islander population, 9.6 (IQR, 6.9-11.6) to 19.1 (IQR, 11.6-24.9) among the Hispanic population, and 9.4 (IQR, 7.4-11.4) to 26.3 (IQR, 20.3-33.3) among the White population. In each year between 1999 and 2019, the Black population had the highest median state MMR. The American Indian and Alaska Native population had the largest increases in median state MMRs between 1999 and 2019. Since 1999, the median of state MMRs has increased for all racial and ethnic groups in the US and the American Indian and Alaska Native; Asian, Native Hawaiian, or Other Pacific Islander; and Black populations each observed their highest median state MMRs in 2019.
CONCLUSION AND RELEVANCE
While maternal mortality remains unacceptably high among all racial and ethnic groups in the US, American Indian and Alaska Native and Black individuals are at increased risk, particularly in several states where these inequities had not been previously highlighted. Median state MMRs for the American Indian and Alaska Native and Asian, Native Hawaiian, or Other Pacific Islander populations continue to increase, even after the adoption of a pregnancy checkbox on death certificates. Median state MMR for the Black population remains the highest in the US. Comprehensive mortality surveillance for all states via vital registration identifies states and racial and ethnic groups with the greatest potential to improve maternal mortality. Maternal mortality persists as a source of worsening disparities in many US states and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis.
Topics: Female; Humans; Pregnancy; Bayes Theorem; Ethnicity; Maternal Mortality; Racial Groups; United States; Child; Adolescent; Young Adult; Adult; Middle Aged
PubMed: 37395772
DOI: 10.1001/jama.2023.9043 -
MMWR. Morbidity and Mortality Weekly... Sep 2019Approximately 700 women die in the United States each year as a result of pregnancy or its complications, and significant racial/ethnic disparities in pregnancy-related...
Approximately 700 women die in the United States each year as a result of pregnancy or its complications, and significant racial/ethnic disparities in pregnancy-related mortality exist (1). Data from CDC's Pregnancy Mortality Surveillance System (PMSS) for 2007-2016 were analyzed. Pregnancy-related mortality ratios (PRMRs) (i.e., pregnancy-related deaths per 100,000 live births) were analyzed by demographic characteristics and state PRMR tertiles (i.e., states with lowest, middle, and highest PRMR); cause-specific proportionate mortality by race/ethnicity also was calculated. Over the period analyzed, the U.S. overall PRMR was 16.7 pregnancy-related deaths per 100,000 births. Non-Hispanic black (black) and non-Hispanic American Indian/Alaska Native (AI/AN) women experienced higher PRMRs (40.8 and 29.7, respectively) than did all other racial/ethnic groups. This disparity persisted over time and across age groups. The PRMR for black and AI/AN women aged ≥30 years was approximately four to five times that for their white counterparts. PRMRs for black and AI/AN women with at least some college education were higher than those for all other racial/ethnic groups with less than a high school diploma. Among state PRMR tertiles, the PRMRs for black and AI/AN women were 2.8-3.3 and 1.7-3.3 times as high, respectively, as those for non-Hispanic white (white) women. Significant differences in cause-specific proportionate mortality were observed among racial/ethnic populations. Strategies to address racial/ethnic disparities in pregnancy-related deaths, including improving women's health and access to quality care in the preconception, pregnancy, and postpartum periods, can be implemented through coordination at the community, health facility, patient, provider, and system levels.
Topics: Adult; Ethnicity; Female; Health Status Disparities; Humans; Pregnancy; Pregnancy Complications; Racial Groups; Risk Factors; United States; Young Adult
PubMed: 31487273
DOI: 10.15585/mmwr.mm6835a3 -
American Journal of Physical... Jun 2021Skin color is the primary physical criterion by which people have been classified into groups in the Western scientific tradition. From the earliest classifications of...
Skin color is the primary physical criterion by which people have been classified into groups in the Western scientific tradition. From the earliest classifications of Linnaeus, skin color labels were not neutral descriptors, but connoted meanings that influenced the perceptions of described groups. In this article, the history of the use of skin color is reviewed to show how the imprint of history in connection with a single trait influenced subsequent thinking about human diversity. Skin color was the keystone trait to which other physical, behavioral, and culture characteristics were linked. To most naturalists and philosophers of the European Enlightenment, skin color was influenced by the external environment and expressed an inner state of being. It was both the effect and the cause. Early investigations of skin color and human diversity focused on understanding the central polarity between "white" Europeans and nonwhite others, with most attention devoted to explaining the origin and meaning of the blackness of Africans. Consistently negative associations with black and darkness influenced philosophers David Hume and Immanuel Kant to consider Africans as less than fully human and lacking in personal agency. Hume and Kant's views on skin color, the integrity of separate races, and the lower status of Africans provided support to diverse political, economic, and religious constituencies in Europe and the Americas interested in maintaining the transatlantic slave trade and upholding chattel slavery. The mental constructs and stereotypes of color-based races remained, more strongly in some places than others, after the abolition of the slave trade and of slavery. The concept of color-based hierarchies of people arranged from the superior light-colored people to inferior dark-colored ones hardened during the late seventeenth century and have been reinforced by diverse forces ever since. These ideas manifest themselves as racism, colorism, and in the development of implicit bias. Current knowledge of the evolution of skin color and of the historical development of color-based race concepts should inform all levels of formal and informal education. Awareness of the influence of color memes and race ideation in general on human behavior and the conduct of science is important.
Topics: Anthropology, Physical; Climate; Enslavement; History, 18th Century; History, 19th Century; Humans; Racial Groups; Racism; Skin Pigmentation
PubMed: 33372701
DOI: 10.1002/ajpa.24200 -
Journal of Experimental Child Psychology Feb 2022Studies examining children's face perception have revealed developmental changes in early and face-sensitive event-related potential (ERP) components. Children also tend...
Studies examining children's face perception have revealed developmental changes in early and face-sensitive event-related potential (ERP) components. Children also tend to show racial biases in their face perception and evaluation of others. The current study examined how early face-sensitive ERPs are influenced by face race in children and adults. A second objective examined face recognition proficiency and implicit racial bias in relation to ERP responses to own- and other-race faces. Electroencephalographic responses were recorded while Caucasian children and adults viewed Caucasian and East Asian faces. Participants also completed recognition tasks and an IAT with Caucasian and East Asian faces. Other-race faces elicited larger P100 amplitudes than own-race faces. Furthermore, adults with better other-race recognition proficiency showed larger P100 amplitude responses to other-race faces compared with adults with worse other-race recognition proficiency. In addition, larger implicit biases favoring own-race individuals were associated with larger P100 to N170 peak-to-peak amplitudes for other-race faces in adults. In contrast, larger implicit biases favoring own-race individuals were associated with smaller P100 to N170 peak-to-peak amplitudes for both own- and other-race faces in 8- to 10-year-olds. There was also an age-related decrease in P100 to N170 peak-to-peak amplitudes for own-race faces among 5- to 10-year-olds with better own-race recognition proficiency. The age-related decrease in N170 latency for other-race faces was also more pronounced in 5- to 10-year-olds with better other-race recognition proficiency. Thus, recognition proficiency and implicit racial bias are associated with early ERP responses in adults and children, but in different ways.
Topics: Adult; Child; Electroencephalography; Evoked Potentials; Facial Recognition; Humans; Pattern Recognition, Visual; Racial Groups; Recognition, Psychology
PubMed: 34507182
DOI: 10.1016/j.jecp.2021.105287 -
New Solutions : a Journal of... Nov 2022Breastfeeding inequities by race are a persistent public health problem in the United States. Inequities in occupation and working conditions likely contribute to... (Review)
Review
Breastfeeding inequities by race are a persistent public health problem in the United States. Inequities in occupation and working conditions likely contribute to relatively less breastfeeding among Black compared to White mothers, yet little research has addressed these interrelationships. Here, we offer a critical review of the literature and a conceptual framework to guide future research about work and racial inequities in breastfeeding. There is a strong public health case for promoting breastfeeding equity for mothers across race groups and occupation types. Existing theory suggests that employment opportunities and working conditions are a likely pathway that connects structural racism to Black-White breastfeeding inequities, in addition to other known factors. We propose a new conceptual model for studying the interrelationships among work, race, and breastfeeding outcomes.
Topics: Female; United States; Humans; Racism; Breast Feeding; Racial Groups; Public Health
PubMed: 36113131
DOI: 10.1177/10482911221124558 -
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 -
Frontiers in Endocrinology 2020In this review, we summarize ethnic/race- and age-related variation in AMH and discuss the underpinnings behind these differences. (Review)
Review
PURPOSE OF REVIEW
In this review, we summarize ethnic/race- and age-related variation in AMH and discuss the underpinnings behind these differences.
RECENT FINDINGS
Anti-mullerian hormone (AMH) has become a widely used method of ovarian reserve testing over the last 15 years. Numerous studies have shown substantial ethnic/race and age-related differences. When compared to age-matched Caucasian women, AMH levels tend to be lower in black and Hispanic women. Chinese women tend to have significantly greater AMH levels prior to age 25 than Caucasian women. When considering subpopulations within ethnicities, at least one study noted lower AMH levels among Maya women compared to other Hispanic women. Age exhibits a positive trend with AMH up until at least 25 years of age with a consistent decline after 34 years of age extending to menopause.
SUMMARY
AMH levels are highly variable among ethnicities and race with higher age-matched levels typically seen in Caucasian women. Age does not exhibit a consistent linear relationship with AMH, but a consistent decline is seen starting in the third decade of life and proceeding to menopause.
Topics: Age Factors; Anti-Mullerian Hormone; Ethnicity; Female; Humans; Ovarian Reserve; Racial Groups
PubMed: 33633682
DOI: 10.3389/fendo.2020.593216